ArticleClinical and molecular hepatology2026
Lack of association between rifaximin and drug-resistant infections: a global multicenter inpatient cirrhosis cohort.
Article in Clinical and molecular hepatology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Gut microbial dynamics and antibiotic resistance during rifaximin therapy in severe cirrhosis: a ProPILA-Rifax ancillary study.Frontiers in cellular and infection microbiology · 2026Trial
- Review
- Editorial: Rifaximin and the Gut-Liver-Brain Axis-Progress and Prudence.Alimentary pharmacology & therapeutics · 2026Article
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15 authors.
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Abstract
BACKGROUND/
aimsInfections with drug-resistant organisms (DROs) are associated with poor outcomes in cirrhosis. Rifaximin, widely used for hepatic encephalopathy (HE), could promote cross-resistance, but data regarding clinical impact are conflicting. Aim: Determine predictors of DROs in a global cirrhosis inpatient cohort focusing on preadmission rifaximin use.
methodsFrom the global CLEARED consortium, we focused on cirrhosis inpatients with infections on/during admission. Clinical/demographic/medication, especially rifaximin details were recorded. The primary outcome was DRO development. Multivariable regression for DRO including clinical, medications, and country income was performed.
results2,949 infected inpatients (55.3 years, 62.9% male) were included. 12.2% of all and 24.4% of culture-positive infections developed DROs; these patients had higher HE (39 vs. 31%, P=0.003), hepatorenal syndrome (25 vs. 19%, P=0.006), lactulose (55 vs. 47%, P=0.008) and rifaximin use (34 vs. 27%, P=0.006) on crude comparisons but country-income distributions were similar. 29.7% were on pre-admission rifaximin, mostly HE-related; they had more advanced cirrhosis and from low/low-middle-income countries. Daptomycin was used in 1.5%, linked with DROs (5.0 vs. 1.0%, P<0.0001) without a difference in rifaximin use (1.4 vs.1.7%, P=0.61). On adjusted analysis, MELD-Na (1.03, 95% CI 1.02-1.04, P<0.001) increased, whereas male sex (0.73, 95% CI 0.58-0.92, P=0.008) and hepatitis-B (0.65, 95% CI 0.45-0.92, P=0.020) decreased DRO. Rifaximin was not associated with DROs overall (OR 1.07, 95% CI 0.80-1.43, P=0.65) or within income strata (high: 1.07, 95% CI 0.59-1.92, P=0.82, upper-middle: 1.18, 95% CI 0.74-1.85, P=0.49, low/low-middle: 1.04, 95% CI 0.60-1.81, P=0.90) despite sensitivity analyses.
conclusionsIn this large global cohort of hospitalized patients with cirrhosis and infections, 12% developed infections involving DROs. 30% had pre-admission rifaximin use which was not linked with daptomycin use or with DRO development on adjusted analysis overall or across country income groups.
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