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. 2021 Sep 13;57(9):964.
doi: 10.3390/medicina57090964.

The Risk of Clostridioides difficile Infection in Cirrhotic Patients Receiving Norfloxacin for Secondary Prophylaxis of Spontaneous Bacterial Peritonitis-A Real Life Cohort

Irina Girleanu  1   2 , Anca Trifan  1   2 , Laura Huiban  1   2 , Cristina Muzica  1   2 , Roxana Nemteanu  1   2 , Andreea Teodorescu  1   2 , Ana Maria Singeap  1   2 , Camelia Cojocariu  1   2 , Stefan Chiriac  1   2 , Oana Petrea  1   2 , Sebastian Zenovia  1   2 , Robert Nastasa  1   2 , Tudor Cuciureanu  1   2 , Carol Stanciu  1   2
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The Risk of Clostridioides difficile Infection in Cirrhotic Patients Receiving Norfloxacin for Secondary Prophylaxis of Spontaneous Bacterial Peritonitis-A Real Life Cohort

Irina Girleanu et al. Medicina (Kaunas). .

Abstract

Background and Objectives: Spontaneous bacterial peritonitis (SBP) is a life-threatening complication of liver cirrhosis. Antibiotic prophylaxis is effective but can lead to an increased incidence of Clostridioides difficile infection (CDI). The aim of this study was to evaluate the incidence of CDI and the risk factors in cirrhotic patients with a previous episode of SBP receiving norfloxacin as secondary prophylaxis. Materials and Methods: We performed a prospective, cohort study including patients with liver cirrhosis and SBP, successfully treated over a 2-year period in a tertiary university hospital. All the patients received secondary prophylaxis for SBP with norfloxacin 400 mg/day. Results: There were 122 patients with liver cirrhosis and SBP included (mean age 57.5 ± 10.8 years, 65.5% males). Alcoholic cirrhosis was the major etiology accounting for 63.1% of cases. The mean MELD score was 19.7 ± 6.1. Twenty-three (18.8%) of all patients developed CDI during follow-up, corresponding to an incidence of 24.8 cases per 10,000 person-years. The multivariate Cox regression analysis demonstrated that alcoholic LC etiology (HR 1.40, 95% CI 1.104-2.441, p = 0.029) and Child-Pugh C class (HR 2.50, 95% CI 1.257-3.850, p = 0.034) were independent risk factors for CDI development during norfloxacin secondary prophylaxis. The development of CDI did not influence the mortality rates in cirrhotic patients with SBP receiving norfloxacin. Conclusions: Cirrhotic patients with SBP and Child-Pugh C class and alcoholic liver cirrhosis had a higher risk of developing Clostridioides difficile infection during norfloxacin secondary prophylaxis. In patients with alcoholic Child-Pugh C class liver cirrhosis, alternative prophylaxis should be evaluated as SBP secondary prophylaxis.

Keywords: Clostridioides difficile infection; liver cirrhosis; norfloxacin; spontaneous bacterial peritonitis.

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Conflict of interest statement

The authors declare no conflict of interest.

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References

    1. Fiore M., Di Franco S., Alfieri A., Passavanti M.B., Pace M.C., Kelly M.E., Damiani G., Leone S. Spontaneous bacterial peritonitis caused by Gram-negative bacteria: An update of epidemiology and antimicrobial treatments. Expert Rev. Gastroenterol. Hepatol. 2019;13:683–692. doi: 10.1080/17474124.2019.1621167. - DOI - PubMed
    1. Ginés P., Rimola A., Planas R., Vargas V., Marco F., Almela M., Forne M., Miranda M.L., Llach J., Salmerón J.M., et al. Norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis: Results of a double-blind, placebo-controlled trial. Hepatology. 1990;12:716–724. doi: 10.1002/hep.1840120416. - DOI - PubMed
    1. Fernández J., del Arbol L.R., Gómez C., Durandez R., Serradilla R., Guarner C., Planas R., Arroyo V., Navasa M. Norfloxacin vs. Ceftriaxone in the Prophylaxis of Infections in Patients With Advanced Cirrhosis and Hemorrhage. Gastroenterology. 2006;131:1049–1056. doi: 10.1053/j.gastro.2006.07.010. - DOI - PubMed
    1. Angeli P., Bernardi M., Villanueva C., Francoz C., Mookerjee R.P., Trebicka J., Krag A., Laleman W., Gines P. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J. Hepatol. 2018;69:406–460. doi: 10.1016/j.jhep.2018.03.024. - DOI - PubMed
    1. Runyon B.A. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology. 2013;57:1651–1653. doi: 10.1002/hep.26359. - DOI - PubMed