What question did this study set out to answer?

This research aims to determine the predictors of drug-resistant infections in hospitalized patients with cirrhosis, focusing on rifaximin use.

April 17, 2026Clinical and Molecular Hepatology0 citationsOpen Access

Lack of Association Between Rifaximin and Drug-resistant Infections: A global multicenter inpatient cirrhosis cohort

JBJasmohan S BajajHunter Holmes McGuire VA Medical Center PKPatrick S KamathMayo Clinic FWFlorence WongUniversity of Toronto

Key Points

This research aims to determine the predictors of drug-resistant infections in hospitalized patients with cirrhosis, focusing on rifaximin use.
Analyzed data from the global CLEARED consortium on cirrhosis inpatients with infections.
Recorded clinical, demographic, and medication details, emphasizing rifaximin use.
Utilized multivariable regression to assess drug-resistant organism development.
12.2% of all infections and 24.4% of culture-positive infections developed drug-resistant organisms.
Pre-admission rifaximin was used by 29.7% of patients with more advanced cirrhosis.
Overall, rifaximin was not significantly linked to drug-resistant infections or daptomycin use.

Abstract

Background/Aims: Infections with drug-resistant organisms (DROs) are associated with poor outcomes in cirrhosis.Rifaximin, widely used for hepatic encephalopathy (HE) could promote cross-resistance, but data regarding clinical impact are conflicting.Aim: Determine predictors of DROs in a global cirrhosis inpatient cohort focusing on pre-admission rifaximin use.Methods: From the global CLEARED consortium, we focused on cirrhosis inpatients with infections on/during admission.Clinical/demographic/medications especially rifaximin details were recorded.The primary outcome was DRO development.Multivariable regression for DRO development including clinical, medications, and country income were performed.Results: 2,949 infected inpatients (55.3 years, 62.9% male) were included.12.2% of all and 24.4% of culture-positive infections developed DROs; these patients had higher HE (39 vs.31%,p=0.003),AKI/HRS (25 vs 19%,p=0.006),lactulose(55 vs.47%,p=0.008)and rifaximin use (34 vs 27%,p=0.006) on crude comparisons but country-income distributions were similar.29.7% were on pre-admission rifaximin, mostly HE-related; they had more advanced cirrhosis and from low/low-middle-income countries.Daptomycin was used in 1.5%, linked with DROs (5.0 vs 1.0%, p<0.0001) without difference in rifaximin use (1.4 vs.1.7%,p=0.61).On adjusted analysis, MELD-Na (1.03,95% CI:1.02-1.04,p<0.001)increased, whereas male sex (0.73,95%CI:0.58-0.92,p=0.008)and HBV (0.65,95%CI:0.45-0.92,p=0.020)decreased DRO.Rifaximin was not associated with DROs overall (OR:1.07,95%CI:0.80-1.43,p=0.65) or within income strata (High:1.07,95%CI:0.59-1.92,p=0.82,Upper-middle:1.18,95%CI:0.74-1.85,p=0.49,low/lowmiddle:1.04,95%CI:0.60-1.81,p=0.90)despite sensitivity analyses.Conclusion: In this large global cohort of hospitalized patients with cirrhosis and infections, 12% developed infections involving DROs.30% had pre-admission rifaximin use which was not linked with daptomycin use, or with with DRO development on adjusted analysis overall or across country income groups.

问 AI

Bookmark

View Full Paper