Gastroenterology Center of Connecticut, 2200 Whitney Avenue, Suite 360, Hamden, CT, 06518, USA.
Division of Digestive Disease, Yale University School of Medicine, New Haven, CT, USA.
Dig Dis Sci. 2020 Feb;65(2):632-638. doi: 10.1007/s10620-019-05804-2. Epub 2019 Aug 22.
Rifaximin is an antimicrobial which is used for prophylaxis of hepatic encephalopathy in patients with cirrhosis and has known anti-Clostridioides difficile activity. The aim of this study is to assess whether the rate of C. difficile infection (CDI) is decreased in patients with cirrhosis on chronic rifaximin compared with those who are not.
We retrospectively identified consecutive patients admitted to Montefiore Medical Center from 2010 to 2014 with cirrhosis and diarrhea who were tested for CDI. Demographics, comorbidities, medication exposure, baseline laboratory data, and outcomes were recorded. Patients with cirrhosis and diarrhea on chronic rifaximin were compared with those not on rifaximin. The chronic rifaximin group was then isolated, and those with and without CDI were compared.
Of 701 patients with cirrhosis and diarrhea, 149 were on chronic rifaximin and 552 were not. 12.8% of patients on chronic rifaximin had CDI compared with 29.7% of those not on rifaximin (P < 0.001). Patients on rifaximin had higher MELD (19.7 vs. 15.5, P < 0.001), 30-day mortality (26.2% vs. 16.1%, P < 0.01), and ICU requirement compared with those not on rifaximin.
Patients with cirrhosis who are on chronic rifaximin have decreased rates of CDI compared with those not on this therapy. Despite its risk for promoting resistance, chronic rifaximin use may have a beneficial effect in preventing CDI in patients with cirrhosis.
利福昔明是一种抗菌药物，用于预防肝硬化患者的肝性脑病，并且已知具有抗艰难梭菌的活性。本研究旨在评估与未接受利福昔明治疗的患者相比，长期接受利福昔明治疗的肝硬化患者艰难梭菌感染（CDI）的发生率是否降低。
我们回顾性地确定了 2010 年至 2014 年期间因肝硬化和腹泻在 Montefiore 医疗中心住院的连续患者，并对其进行了 CDI 检测。记录了人口统计学、合并症、药物暴露、基线实验室数据和结局。将接受慢性利福昔明治疗的肝硬化伴腹泻患者与未接受利福昔明治疗的患者进行比较。然后将慢性利福昔明组隔离，并比较有和没有 CDI 的患者。
在 701 例肝硬化伴腹泻患者中，149 例接受慢性利福昔明治疗，552 例未接受利福昔明治疗。接受慢性利福昔明治疗的患者中 CDI 的发生率为 12.8%，而未接受利福昔明治疗的患者中 CDI 的发生率为 29.7%（P<0.001）。接受利福昔明治疗的患者 MELD 评分（19.7 与 15.5，P<0.001）、30 天死亡率（26.2%与 16.1%，P<0.01）和 ICU 需求均高于未接受利福昔明治疗的患者。
与未接受该治疗的患者相比，接受慢性利福昔明治疗的肝硬化患者 CDI 的发生率较低。尽管利福昔明有促进耐药性的风险，但慢性利福昔明的使用可能对预防肝硬化患者的 CDI 有有益的作用。
