Lack of association between rifaximin and drug-resistant infections: a global multicenter inpatient cirrhosis cohort
Clinical and Molecular Hepatology, cilt.32, sa.3, ss.1321-1332, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 32 Sayı: 3
- Basım Tarihi: 2026
- Doi Numarası: 10.3350/cmh.2026.0228
- Dergi Adı: Clinical and Molecular Hepatology
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, MEDLINE, Directory of Open Access Journals, Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest)
- Sayfa Sayıları: ss.1321-1332
- Anahtar Kelimeler: Antibiotic overuse, CLEARED consortium, Daptomycin, Disparities, Infections
- Açık Arşiv Koleksiyonu: AVESİS Açık Erişim Koleksiyonu
- Ankara Üniversitesi Adresli: Evet
Özet
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 admis-sion. Clinical/demographic/medication, especially rifaximin details were recorded. The primary outcome was DRO development. Multivariable regression for DRO including clinical, medications, and country income was 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), hepatorenal syndrome (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 a 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 hepatitis-B (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/low-middle: 1.04, 95% CI 0.60–1.81, P=0.90) despite sensitivity analyses. Conclusions: 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 DRO development on adjusted analysis overall or across country income groups. (Clin Mol Hepatol 2026;32:1321-1332).