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CC BY-NC-ND 4.0 · Journal of Gastrointestinal Infections 2023; 13(01): 026-029
DOI: 10.1055/s-0042-1757401
Original Article

Clostridioides difficile Infection in Patients with Cirrhosis Treated for Hepatic Encephalopathy

Kanika Sehgal
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Clayton M. Spiceland
2   Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States
,
Ryan J. Lennon
3   Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, United States
,
Darrell S. Pardi
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Sahil Khanna 
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
› Institutsangaben Funding This work was supported by an unrestricted research grant from Salix pharmaceuticals.
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Abstract

Introduction Hospitalizations, proton-pump inhibitors (PPI), and systemic antibiotics increase the risk of Clostridioides difficile infection (CDI) in cirrhosis. We compare the risk of CDI with hepatic encephalopathy (HE) medications, hypothesizing that rifaximin may decrease CDI risk.

Materials and Methods A retrospective study of hospitalized HE patients treated with lactulose and/or rifaximin at Mayo Clinic Minnesota, Florida, and Arizona from 2008 to 2013 was conducted. Data on demographics, hospitalizations, antibiotics, and PPI use and CDI were gathered. Univariate and multivariable cox models were constructed.

Results We found 1,112 hospitalizations in 1,055 unique patients (55 had 1 subsequent readmission, 1 patient had 2); 428 (40.6%) patients were women (median age: 58 years [interquartile range: 52–65]). CDI developed after 66/1,112 (5.9%) hospitalizations within 12 months post-discharge. Lactulose was administered in 21 (31.8%), rifaximin in 5 (7.6%), both in 40 (60.6%) hospitalizations. Systemic antibiotics were used in 28 (42.4%) patients and PPIs in 60 (90.9%) patients.

Univariate analysis using medication (with lactulose alone as the reference group) showed rifaximin was not significantly associated with CDI compared with lactulose (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 0.57–4.33, p = 0.39). Use of both medications was not significant compared with lactulose (HR: 1.41, 95% CI: 0.84–2.38, p = 0.19). Results were similar after controlling for confounders. Multivariable analysis based on length of stay, age, and gender showed no differences between rifaximin versus lactulose and both versus lactulose.

Conclusion There is no significant difference between lactulose and rifaximin on CDI development in HE patients. However, CDI should still be considered when managing diarrhea in HE patients.

Keywords

cirrhosis - Clostridioides difficile - hepatic encephalopathy - lactulose - rifaximin

Note

These data were presented as a poster at American College of Gastroenterology 2021.


Ethics Approval

This study was approved by the ethic committee.




Publikationsverlauf

Eingereicht: 08. April 2022

Angenommen: 20. Juni 2022

Artikel online veröffentlicht:
22. September 2023

© 2023. Gastroinstestinal Infection Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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