title: Impact of rifaximin use for hepatic encephalopathy on the risk of early post-transplant infections in liver transplant recipients.
abstract: BACKGROUND
  Whether the use of rifaximin for hepatic encephalopathy during liver transplant candidacy has an impact on post-transplant infections is not known.
  
  
  METHODS
  We compared the frequency and spectrum of infections within 90 d post-transplant in liver transplant recipients who did and did not receive rifaximin for hepatic encephalopathy during transplant candidacy.
  
  
  RESULTS
  Of 110 consecutive liver transplant recipients, 30 (27%) received rifaximin. Rifaximin users were more severely ill based on higher Model for End-Stage Liver Disease (MELD) score (p=0.005). When controlled for MELD (stratified by MELD<30, MELD≥30), the risk of infections was significantly lower in rifaximin vs. no rifaximin recipients (OR=0.269, 95% CI 0.078-0.0.934, p=0.026). Rifaximin use was not associated with a higher risk of multidrug resistant bacterial infections (OR=1.8, 95% CI 0.42-8.35, p=0.40). The probability of post-transplant survival at 90 d did not differ for patients with or without rifaximin use (0.90 for both groups, p=0.56).
  
  
  CONCLUSIONS
  Rifaximin appeared to have a protective effect against early post-transplant infections in more severely ill liver transplant recipients. Rifaximin use did not select for multidrug resistant bacteria in these patients.
authors.affiliation: Veterans Affairs Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA 15240, USA.
authors.forename: Hsin-Yun
authors.initials: HY
authors.lastname: Sun
authors.forename: Marilyn
authors.initials: M
authors.lastname: Wagener
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Cacciarelli
authors.forename: Nina
authors.initials: N
authors.lastname: Singh
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality; D006501:Hepatic Encephalopathy / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D006801:Humans; D007239:Infections / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012294:Rifamycins / Q000627:therapeutic use*; D000078262:Rifaximin; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D000890:Anti-Infective Agents; D012294:Rifamycins; D000078262:Rifaximin