The Role of Rifaximin in the Primary Prophylaxis of Bacterial Infections Other Than Spontaneous Bacterial Peritonitis in Patients with Liver Cirrhosis

Purpose: Recent study showed that intestinal decontamination with rifaximin prevents spontaneous bacterial peritonitis (SBP) in cirrhotic patients with ascites. However, it remains to be determined whether rifaximin prevents infections other than SBP in patients with liver cirrhosis. The aim of the present study is to determine whether rifaximin prevents infections other than SBP in cirrhotic patients. Methods: We identified all adult patients with liver cirrhosis who were referred to our institution between January, 2003 and June, 2007 (N=664), of whom 49 patients received rifaximin therapy and served as study group. A control group of patients with liver cirrhosis who were not on rifaximin was matched 1:1 with the study group based on age and MELD score using a greedy algorithm. Infections were defined by isolation of any bacterial organisms in the body fluids. The rates of infections were estimated by dividing the number of infections by the number of patient years-follow-up. In addition, time-to-infection analysis was performed. Results: A total of 98 patients were included in the study, of whom 49 were on rifaximin therapy and 49 were not. The two groups were comparable with regards to sex and race. The mean MELD and Child's Pugh scores of the entire cohort were 16.9±7.3 and 11.1±1.4, respectively. The median follow-up time was 8.2 months, during which 50% of patients had at least one infection other than SBP (24.5% had 1 infection and 25.5% had +2 infections). The rifaximin patients developed a total of 45 infections other than SBP (infection rate 0.77), as compared with 54 infections (infection rate 0.70) in the non-rifaximin group (p=0.65). After adjusting for Child-Pugh score, there was no reduction in the rate of non-SBP infections in the rifaximin group (hazard ratio=0.63; 95% confidence interval, 0.37-1.05; P=0.074). Conclusion: There is no evidence to suggest that intestinal decontamination with rifaximin causes a significant decrease in the rate of infections other than SBP in patients with liver cirrhosis.Figure