Bacterial and
fungal infections are major causes of morbidity and mortality after
liver transplantation (LT). The role of intestinal decontamination in the prevention of post-LT
infections is controversial.
Rifaximin is widely used for the treatment of
hepatic encephalopathy. The effect of
rifaximin on post-LT
infections is unknown. The aim of our study was to determine the effect of
rifaximin therapy in the pretransplant period on early
bacterial infections (
EBIs) and
fungal infections within the first 30 days after LT. All adult patients who underwent LT at our institution (January 2009 to July 2011) were included in this retrospective cohort study. Patients receiving
antibiotics other than pretransplant protocol
antibiotics were excluded. Patients were stratified into 2 groups based on the presence or absence of
rifaximin therapy for at least 2 days before LT.
Infections were defined by the isolation of any bacterial or fungal organisms within 30 days of LT. Multivariate regression analysis, Student t tests, and Pearson's chi-square tests were used to compare the 2 groups. Two hundred sixty-eight patients were included, and 71 of these patients (26.5%) were on
rifaximin at the time of LT. The 2 groups were comparable with respect to age, sex, race, and Model for
End-Stage Liver Disease score. There were no significant differences in the rates of
EBIs (30% for the non-
rifaximin group and 25% for the
rifaximin group, P = 0.48) or
fungal infections between the 2 groups. There was no increase in antimicrobial resistance among the infecting organisms. There was no difference in survival between the
rifaximin and non-
rifaximin groups (98% versus 97%, P = 0.36). In conclusion, the use of
rifaximin in the pre-LT period was not associated with an increased risk of bacterial or
fungal infections in the early post-LT period.