ArticleNature communications2025
Increased risk of antimicrobial resistance in patients with cirrhosis and hepatic encephalopathy using rifaximin.
Article in Nature communications, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
4 citing papers in PubMed.
- Choosing real-world data for clinical and epidemiological research: methodological lessons from NHIRD and TriNetX-A narrative review.Annals of medicine · 2026Review
- Lack of association between rifaximin and drug-resistant infections: a global multicenter inpatient cirrhosis cohort.Clinical and molecular hepatology · 2026Article
- Reducing the Risk of Overt Hepatic Encephalopathy Recurrence: A Narrative Review.Journal of clinical and translational hepatology · 2026Review
- Real-world evidence on predictors of antimicrobial resistance among patients with chronic liver disease.Frontiers in medicine · 2026Article
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Rifaximin, a non-absorbable antibiotic used in managing recurrent hepatic encephalopathy (HE), has traditionally been considered low risk for inducing resistance. However, emerging evidence raised concerns that widespread rifaximin use may promote antimicrobial resistance (AMR). In this multi-national retrospective cohort study, we evaluate the association between rifaximin use and subsequent AMR in patients with cirrhosis and HE. After propensity score matching for 78 covariates, hazard ratios (HRs) and 95% confidence intervals (CIs) for AMR and infection-related adverse events are calculated for the one-year follow-up. We demonstrate a two-fold AMR risk associated with rifaximin use (HR = 1.89; 95% CI = 1.49-2.40), with significantly increased risks of vancomycin resistance (HR = 2.52; 95% CI = 1.64-3.88) and multidrug resistance (HR = 2.31; 95% CI = 1.38-3.85). Rifaximin use is also associated with an escalated risk of sepsis, spontaneous bacterial peritonitis, and the use of last-line antibiotics. Notably, patients receiving other antibiotics prior to rifaximin treatment exhibit greater AMR risks. These findings challenge the conventional view of rifaximin as a low-risk intervention and support mechanistic evidence linking rifaximin exposure to cross-resistance against critical antibiotics with real-world evidence.
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