Impact of rifaximin on the frequency and characteristics of spontaneous bacterial peritonitis in patients with liver cirrhosis and ascites.
BACKGROUND
Rifaximin is a non-absorbable antibiotic used to prevent relapses of hepatic encephalopathy which may also be a candidate for prophylaxis of spontaneous bacterial peritonitis (SBP).


OBJECTIVE
To detect the impact of rifaximin on the occurrence and characteristics of SBP.


METHODS
We prospectively studied all hospitalized patients that underwent a diagnostic paracentesis in our department from March 2012 to April 2013 for SBP and recorded all clinical data including type of SBP prophylaxis, prior use of rifaximin, concomitant complications of cirrhosis, as well as laboratory results and bacteriological findings. Patients were divided into the following three groups: no antibiotic prophylaxis, prophylaxis with rifaximin or with systemically absorbed antibiotic prophylaxis.


RESULTS
Our study cohort comprised 152 patients with advanced liver cirrhosis, 32 of whom developed SBP during the study period. As expected, our study groups differed regarding a history of hepatic encephalopathy and SBP before inclusion into the study. None of the 17 patients on systemic antibiotic prophylaxis developed SBP while 8/27 patients on rifaximin and 24/108 without prophylaxis had SBP (p = 0.02 and p = 0.04 versus systemic antibiotics, respectively). In general, episodes of SBP were similar for patients treated with rifaximin and those without any prophylaxis. However, Escherichia coli and enterococci were dominant in the ascites of patients without any prophylaxis, while mostly klebsiella species were recovered from the ascites samples in the rifaximin group.


CONCLUSIONS
Rifaximin pretreatment did not lead to a reduction of SBP occurrence in hospitalized patients with advanced liver disease. However, the bacterial species causing SBP were changed by rifaximin.
Department of Internal Medicine I, University of Bonn, Bonn, Germany; German Center for Infection Research.
Philipp
P
Lutz
Institute for Medical Microbiology, Immunology and Parasitology, University of Bonn, Bonn, Germany; German Center for Infection Research.
Marijo
M
Parcina
Institute for Medical Microbiology, Immunology and Parasitology, University of Bonn, Bonn, Germany; German Center for Infection Research.
Isabelle
I
Bekeredjian-Ding
Department of Internal Medicine I, University of Bonn, Bonn, Germany; German Center for Infection Research.
Hans Dieter
HD
Nischalke
Department of Internal Medicine I, University of Bonn, Bonn, Germany; German Center for Infection Research.
Jacob
J
Nattermann
Department of Internal Medicine I, University of Bonn, Bonn, Germany.
Tilman
T
Sauerbruch
Institute for Medical Microbiology, Immunology and Parasitology, University of Bonn, Bonn, Germany; German Center for Infection Research.
Achim
A
Hoerauf
Department of Internal Medicine I, University of Bonn, Bonn, Germany; German Center for Infection Research.
Christian P
CP
Strassburg
Department of Internal Medicine I, University of Bonn, Bonn, Germany; German Center for Infection Research.
Ulrich
U
Spengler
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001201:Ascites / Q000150:complications*; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control*; D016983:Enterococcus / Q000302:isolation & purification; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D006801:Humans; D007709:Klebsiella / Q000302:isolation & purification; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000150:complications / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control*; D011446:Prospective Studies; D012294:Rifamycins / Q000627:therapeutic use*; D000078262:Rifaximin; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D012294:Rifamycins; D000078262:Rifaximin