2384. The Relationship Between Rifaxamin Use and the Prevalence of Clostridiodes difficile and Vancomycin-Resistant Enterococcus in Patients with Advanced Liver Disease

BACKGROUND: Rifaximin (RFX) is a minimally absorbed antibiotic that achieves high concentrations after administration in the gut lumen. Previously, RFX showed activity against Clostridiodes difficile (C. difficile) recurrences post treatment with little overall impact on the normal fecal microbiota. Additional studies have found that while exposure to systemic antibiotics was associated with infection with multi drug-resistant organisms, such as VRE, exposure to only RFX was not. RFX has become widely used in hospitalized patients with advanced liver disease (ALD) who have refractory hepatic encephalopathy, but the impact of therapy on the occurrence of C. difficile and VRE is not well established. METHODS: ALD patients in the Vizient Clinical Database-Resource Manager (CDB-RM®) were identified based on ICD 10 and MS-DRG codes from January to December 2018. The data were further stratified based on receipt of RFX, documentation of C. difficile or VRE, and hospital type (academic medical centers, complex care medical centers or community hospitals). Wilcoxon signed-rank test was used to compare C. difficile rates while paired samples t-test was used to compare VRE. Chi-square analysis was used to evaluate differences in RFX use by hospital type. RESULTS: A total of 527,534 cases from 419 acute care hospitals were included in the ALD cohort. The frequency of C. difficile occurrence in patients who received RFX was lower than those who did not receive RFX (3.8% vs 4.3%, respectively, P = 0.25), However, VRE frequency was significantly lower in those that received RFX (0.43 cases per 10,000 patient-days) vs. the overall ALD population (2.3 cases per 10,000 patient-days) (P < 0.05). Percentage of ALD cases receiving RFX in the academic medical centers, complex care medical centers and community hospitals was 11.94%, 4.87%, and 8.76%, respectively (P < 0.05). CONCLUSION: Patients with ALD who received RFX had a significantly lower frequency of documented VRE. There was a trend in the reduction in documented C. difficile, but this did not reach statistical significance. Utilization of RFX varied significantly by institutional type. These results support further studies on the relationship between receipt of RFX and protective effects against C. difficile and VRE in patients with ALD. DISCLOSURES: All authors: No reported disclosures.