Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón.
Medicine Department, School of Medicine, Universidad Complutense de Madrid.
Clin Infect Dis. 2018 Mar 19;66(7):1086-1091. doi: 10.1093/cid/cix918.
Patients with cirrhosis are at high risk of Clostridium difficile infection (CDI). Rifaximin is commonly used in cirrhotic patients as prophylaxis for hepatic encephalopathy (HE). Several studies have demonstrated the efficacy of rifaximin in the treatment of CDI; however, resistance to rifaximin has also been reported. Few studies have assessed the risk of developing CDI in cirrhotic patients receiving rifaximin. Our objective was to assess the incidence and characteristics of CDI in patients with cirrhosis, especially in those who received rifaximin.
We assessed the incidence and clinical characteristics of CDI in cirrhotic patients over a 6-year period in our hospital. Medical charts were retrospectively reviewed. Ribotyping and antimicrobial susceptibility testing of all strains against rifaximin were performed.
A total of 388 cirrhotic patients were included, of whom 127 patients had at least 1 episode of diarrhea in which a sample was sent to the laboratory. CDI was detected in 46 patients. Fourteen patients (30.4%) were receiving rifaximin as prophylaxis for HE. The main ribotypes detected were 001 (30.4%), followed by 014 (19.6%). Resistance to rifaximin was 34.1% overall, and 84.6% in patients who had received rifaximin. Multivariate analysis showed that rifamycin therapy and ribotype 001 were significant risk factors for having a rifaximin-resistant C. difficile strain.
A high percentage of CDI cases were detected in cirrhotic patients receiving rifaximin, mostly owing to selection of rifaximin-resistant C. difficile strains. Clinicians should be aware of the risk of CDI in cirrhotic patients, even in those receiving rifaximin.
肝硬化患者发生艰难梭菌感染（CDI）的风险较高。利福昔明常被用于肝硬化患者以预防肝性脑病（HE）。有几项研究已经证明了利福昔明在治疗 CDI 方面的疗效；然而，也有报道称其存在耐药性。很少有研究评估接受利福昔明治疗的肝硬化患者发生 CDI 的风险。我们的目的是评估肝硬化患者中 CDI 的发生率和特征，特别是那些接受利福昔明治疗的患者。
我们在我院评估了 6 年内肝硬化患者中 CDI 的发生率和临床特征。回顾性分析病历。对所有菌株进行核糖体分型和对利福昔明的药敏试验。
共纳入 388 例肝硬化患者，其中 127 例至少有 1 次腹泻发作，且有样本送往实验室。共检出 46 例 CDI。14 例（30.4%）患者正在接受利福昔明预防 HE。主要的核糖体型为 001（30.4%），其次是 014（19.6%）。总体耐药率为 34.1%，接受利福昔明治疗的患者耐药率为 84.6%。多变量分析显示，利福霉素治疗和核糖体型 001 是发生利福昔明耐药艰难梭菌菌株的显著危险因素。
在接受利福昔明治疗的肝硬化患者中，检测到较高比例的 CDI 病例，主要是由于选择了利福昔明耐药的艰难梭菌菌株。临床医生应意识到肝硬化患者发生 CDI 的风险，即使是那些接受利福昔明治疗的患者。
