Kanika Sehgal, MBBS1, Clayton M. Spiceland, MD2, Ryan Lennon, MS1, Darrell Pardi, MD, MS1, Sahil Khanna, MBBS, MS1 1Mayo Clinic, Rochester, MN; 2TriStar Southern Hills Medical Center, Nashville, TN
Introduction: Frequent hospitalizations, systemic antibiotics and proton-pump inhibitor (PPI) use are risk factors for Clostridioides difficile infection (CDI) in patients with cirrhosis. Hepatic encephalopathy (HE), a complication of cirrhosis, is managed with lactulose and/or rifaximin. Studies show a potential decrease in the risk of CDI with these therapies but have not compared the two treatments. We compare the effect of lactulose and rifaximin treatment on the risk of CDI development hypothesizing that rifaximin, given its activity against C. difficile, may decrease the risk of CDI.
Methods: This was a multi-center retrospective study of all hospitalized cirrhotic patients treated for HE with lactulose and/or rifaximin at Mayo Clinic MN, FL and AZ from 2008-2013. Data on demographics, medications, admission, discharge, previous hospitalizations, antibiotic and PPI use, and dates of CDI episodes were gathered.
Results: A total of 1112 hospitalizations in 1055 unique patients (55 had 1 subsequent readmission and 1 patient had 2) were found. Of these, 428 (40.6%) women with median age 58 years (interquartile range 52-65). C. difficile infection developed after 66/1112 (5.9%) hospitalizations within 12 months post-discharge. Of these, lactulose was administered in 21 (31.8%) hospitalizations, rifaximin in 5 (7.6%) and both in 40 (60.6%) hospitalizations. Systemic antibiotics were used in 28 (42.4%) admissions and PPIs in 60 (90.9%).
Univariate analysis based only on medication (using lactulose alone as the reference group), regardless of dosage, showed that rifaximin alone was not significantly associated with CDI development as compared to lactulose alone (HR 1.57, 95% CI 0.57-4.33, p=0.39). Use of both medications was also not significant when compared to lactulose alone (HR 1.41, 95% CI 0.84-2.38, p=0.19). The results were similar after controlling for confounder variables. Multivariable analysis based on length of stay, age and gender showed no significant difference between rifaximin alone versus lactulose alone, and both medications versus lactulose alone for developing CDI.
Discussion: In our study, there was no significant difference between lactulose and rifaximin treatment on CDI development in patients with HE. While the use of both these medications might be safe, CDI should still be considered when managing HE in cirrhotic patients who develop diarrhea.
Disclosures: Kanika Sehgal indicated no relevant financial relationships. Clayton Spiceland indicated no relevant financial relationships. Ryan Lennon indicated no relevant financial relationships. Darrell Pardi indicated no relevant financial relationships. Sahil Khanna indicated no relevant financial relationships.
Kanika Sehgal, MBBS1, Clayton M. Spiceland, MD2, Ryan Lennon, MS1, Darrell Pardi, MD, MS1, Sahil Khanna, MBBS, MS1. P0133 - Clostridioides difficile Infection in Hospitalized Patients With Cirrhosis Treated for Hepatic Encephalopathy, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.