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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

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...

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Autores principales: Girleanu, Irina, Trifan, Anca, Huiban, Laura, Muzica, Cristina, Nemteanu, Roxana, Teodorescu, Andreea, Singeap, Ana Maria, Cojocariu, Camelia, Chiriac, Stefan, Petrea, Oana, Zenovia, Sebastian, Nastasa, Robert, Cuciureanu, Tudor, Stanciu, Carol
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8464987/
https://www.ncbi.nlm.nih.gov/pubmed/34577887
http://dx.doi.org/10.3390/medicina57090964
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author Girleanu, Irina
Trifan, Anca
Huiban, Laura
Muzica, Cristina
Nemteanu, Roxana
Teodorescu, Andreea
Singeap, Ana Maria
Cojocariu, Camelia
Chiriac, Stefan
Petrea, Oana
Zenovia, Sebastian
Nastasa, Robert
Cuciureanu, Tudor
Stanciu, Carol
author_facet Girleanu, Irina
Trifan, Anca
Huiban, Laura
Muzica, Cristina
Nemteanu, Roxana
Teodorescu, Andreea
Singeap, Ana Maria
Cojocariu, Camelia
Chiriac, Stefan
Petrea, Oana
Zenovia, Sebastian
Nastasa, Robert
Cuciureanu, Tudor
Stanciu, Carol
author_sort Girleanu, Irina
collection PubMed
description 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.
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spelling pubmed-84649872021-09-27 The Risk of Clostridioides difficile Infection in Cirrhotic Patients Receiving Norfloxacin for Secondary Prophylaxis of Spontaneous Bacterial Peritonitis—A Real Life Cohort Girleanu, Irina Trifan, Anca Huiban, Laura Muzica, Cristina Nemteanu, Roxana Teodorescu, Andreea Singeap, Ana Maria Cojocariu, Camelia Chiriac, Stefan Petrea, Oana Zenovia, Sebastian Nastasa, Robert Cuciureanu, Tudor Stanciu, Carol Medicina (Kaunas) Article 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. MDPI 2021-09-13 /pmc/articles/PMC8464987/ /pubmed/34577887 http://dx.doi.org/10.3390/medicina57090964 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Girleanu, Irina
Trifan, Anca
Huiban, Laura
Muzica, Cristina
Nemteanu, Roxana
Teodorescu, Andreea
Singeap, Ana Maria
Cojocariu, Camelia
Chiriac, Stefan
Petrea, Oana
Zenovia, Sebastian
Nastasa, Robert
Cuciureanu, Tudor
Stanciu, Carol
The Risk of Clostridioides difficile Infection in Cirrhotic Patients Receiving Norfloxacin for Secondary Prophylaxis of Spontaneous Bacterial Peritonitis—A Real Life Cohort
title The Risk of Clostridioides difficile Infection in Cirrhotic Patients Receiving Norfloxacin for Secondary Prophylaxis of Spontaneous Bacterial Peritonitis—A Real Life Cohort
title_full The Risk of Clostridioides difficile Infection in Cirrhotic Patients Receiving Norfloxacin for Secondary Prophylaxis of Spontaneous Bacterial Peritonitis—A Real Life Cohort
title_fullStr The Risk of Clostridioides difficile Infection in Cirrhotic Patients Receiving Norfloxacin for Secondary Prophylaxis of Spontaneous Bacterial Peritonitis—A Real Life Cohort
title_full_unstemmed The Risk of Clostridioides difficile Infection in Cirrhotic Patients Receiving Norfloxacin for Secondary Prophylaxis of Spontaneous Bacterial Peritonitis—A Real Life Cohort
title_short The Risk of Clostridioides difficile Infection in Cirrhotic Patients Receiving Norfloxacin for Secondary Prophylaxis of Spontaneous Bacterial Peritonitis—A Real Life Cohort
title_sort risk of clostridioides difficile infection in cirrhotic patients receiving norfloxacin for secondary prophylaxis of spontaneous bacterial peritonitis—a real life cohort
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8464987/
https://www.ncbi.nlm.nih.gov/pubmed/34577887
http://dx.doi.org/10.3390/medicina57090964
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