The Risk of Clostridioides difficile Infection in Cirrhotic Patients Receiving Norfloxacin for Secondary Prophylaxis of Spontaneous Bacterial Peritonitis—A Real Life Cohort
| Autor: | Andreea Teodorescu, Camelia Cojocariu, Robert Nastasa, Ana-Maria Singeap, Anca Trifan, Laura Huiban, Stefan Chiriac, Oana Petrea, Tudor Cuciureanu, Cristina Maria Muzica, Sebastian Zenovia, Roxana Nemteanu, Carol Stanciu, Irina Girleanu |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Alcoholic liver disease Medicine (General) Cirrhosis business.industry Clostridioides difficile infection Mortality rate Incidence (epidemiology) liver cirrhosis norfloxacin General Medicine medicine.disease Gastroenterology spontaneous bacterial peritonitis Spontaneous bacterial peritonitis R5-920 Internal medicine medicine Antibiotic prophylaxis business Norfloxacin medicine.drug Cohort study |
| Zdroj: | Medicina Volume 57 Issue 9 Medicina, Vol 57, Iss 964, p 964 (2021) |
| ISSN: | 1648-9144 |
| DOI: | 10.3390/medicina57090964 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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