Abstract
BackgroundRifaximin is a non-absorbable antibiotic used to prevent relapses of hepatic encephalopathy which may also be a candidate for prophylaxis of spontaneous bacterial peritonitis (SBP).AimTo detect the impact of rifaximin on the occurrence and characteristics of SBP.MethodsWe prospectively studied all hospitalized patients that underwent a diagnostic paracentesis in our department from March 2012 to April 2013 for SBP and recorded all clinical data including type of SBP prophylaxis, prior use of rifaximin, concomitant complications of cirrhosis, as well as laboratory results and bacteriological findings. Patients were divided into the following three groups: no antibiotic prophylaxis, prophylaxis with rifaximin or with systemically absorbed antibiotic prophylaxis.ResultsOur study cohort comprised 152 patients with advanced liver cirrhosis, 32 of whom developed SBP during the study period. As expected, our study groups differed regarding a history of hepatic encephalopathy and SBP before inclusion into the study. None of the 17 patients on systemic antibiotic prophylaxis developed SBP while 8/27 patients on rifaximin and 24/108 without prophylaxis had SBP (p = 0.02 and p = 0.04 versus systemic antibiotics, respectively). In general, episodes of SBP were similar for patients treated with rifaximin and those without any prophylaxis. However, Escherichia coli and enterococci were dominant in the ascites of patients without any prophylaxis, while mostly klebsiella species were recovered from the ascites samples in the rifaximin group.ConclusionRifaximin pretreatment did not lead to a reduction of SBP occurrence in hospitalized patients with advanced liver disease. However, the bacterial species causing SBP were changed by rifaximin.
Highlights
Spontaneous bacterial peritonitis (SBP) is a distinct form of infectious peritonitis occurring in patients with advanced liver cirrhosis and ascites [1]
The bacterial species causing spontaneous bacterial peritonitis (SBP) were changed by rifaximin
Group 1 comprised all patients without prophylaxis, group 2 all patients receiving rifaximin and group 3 all patients with systemically absorbed antibiotic prophylaxis that was given as primary or secondary SBP prophylaxis according to international guidelines [12]
Summary
Spontaneous bacterial peritonitis (SBP) is a distinct form of infectious peritonitis occurring in patients with advanced liver cirrhosis and ascites [1]. Recurrence of SBP is common [3], but can be prevented by secondary prophylaxis with systemic antibiotics [4]. Hepatic encephalopathy (HE) is considered to result from inadequate detoxification of intestinal toxins produced by intestinal bacteria. Prevention of recurrent HE is achieved by administering lactulose, which alters the composition of intestinal bacteria. Rifaximin, a non-absorbable antibiotic, has been introduced as a novel agent to prevent recurrent HE [7,8]. Rifaximin is a non-absorbable antibiotic used to prevent relapses of hepatic encephalopathy which may be a candidate for prophylaxis of spontaneous bacterial peritonitis (SBP)
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