Abstract
It is unclear whether norfloxacin predisposes to infections by multidrug-resistant organisms (MDROs). We aimed to evaluate if patients with cirrhosis receiving norfloxacin prophylaxis at the time of the diagnosis of bacterial infections were more likely to present a multidrug-resistant isolate than those without prophylaxis. This is a cross-sectional study of hospitalized patients with cirrhosis and bacterial infections from Argentina and Uruguay (NCT03919032) from September 2018 to December 2020. The outcome variable was a multidrug-resistant bacterial infection. We used inverse probability of treatment weighting to estimate the odds ratio (OR) of norfloxacin on infection caused by MDROs considering potential confounders. Among the 472 patients from 28 centers, 53 (11%) were receiving norfloxacin at the time of the bacterial infection. Patients receiving norfloxacin had higher MELD-sodium, were more likely to have ascites or encephalopathy, to receive rifaximin, beta-blockers, and proton-pump inhibitors, to have a nosocomial or health-care-associated infection, prior bacterial infections, admissions to critical care units or invasive procedures, and to be admitted in a liver transplant center. In addition, we found that 13 (24.5%) patients with norfloxacin and 90 (21.5%) of those not receiving it presented infections caused by MDROs (adjusted OR 1.55; 95% CI: 0.60–4.03; p = 0.360). The use of norfloxacin prophylaxis at the time of the diagnosis of bacterial infections was not associated with multidrug resistance. These results help empiric antibiotic selection and reassure the current indication of norfloxacin prophylaxis in well-selected patients.
Study registration number: NCT03919032
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The datasets generated during and/or analyzed during the current study are not publicly available but are available from the corresponding author upon reasonable request.
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Abbreviations
- MDRO:
-
Multidrug-resistant organisms
- SBP:
-
Spontaneous bacterial peritonitis
- ESBLs:
-
Extended-spectrum B-lactamase
- MRSA:
-
Methicillin-resistant Staphylococcus aureus
- CNSA:
-
Coagulase-negative Staphylococcus
- VRE:
-
Vancomycin-resistant Enterococci
- CPE:
-
Carbapenemase-producing Enterobacteriaceae
- MDR:
-
Multidrug resistant
- INR:
-
International normalized ratio
- OR:
-
Odds ratio
- ATE:
-
Average treatment effect
- IPTW:
-
Inverse probability of treatment weights
- MAR:
-
Missing at random
- HCA:
-
Health-care-associated
- IQR:
-
Interquartile range
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Acknowledgements
We would like to acknowledge the Argentinean Association for the Study of the Liver, which facilitated this project. In addition, we thank the patients and families who voluntarily agreed to participate in this project.
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Sebastián, Marciano, MD, MsC; Maria, N, Gutierrez-Acevedo, Astrid, Smud, MD; Adrian, C, Gadano, MD, PhD; and Diego, H, Giunta, MD, PhD, contributed to the study conception and design, material preparation, and data collection.
Sebastián, Marciano, MD, and Giunta, MD, PhD, performed the analyses and the first draft of the manuscript.
All authors read and approved the final manuscript and performed data collection.
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Sebastián, Marciano, MD, MsC; Maria, N, Gutierrez-Acevedo, MD; Sabrina, Barbero, MD; Lorena, Notari, MD; Marina, Agozino, MD; Jose, L, Fernandez, MD; Maria M, Anders, MD; Nadia, Grigera, MD; Florencia, Antinucci, MD; Orlando, F, Orozco Ganem, MD; Maria, D, Murga, MD; Daniela, Perez, MD; Ana, Palazzo, MD; Liria, Martinez Rejtman, MD; Ivonne, G, Duarte, MD; Julio, Vorobioff, MD; Victoria, Trevizan, MD; Sofía, Bulaty, MD; Fernando, Bessone, MD; Marcelo, Valverde, MD; Martín, Elizondo, MD; José, D, Bosia, MD; Silvia, M, Borzi, MD; Teodoro, E, Stieben, MD; Adriano, Masola, MD; Sebastian, E, Ferretti, MD; Diego, Arufe, MD; Ezequiel, Demirdjian, MD; Maria, P, Raffa, MD; Mirta, Peralta, MD; Hugo, A, Fainboim, MD; Cintia, E, Vazquez, MD; Pablo, Ruiz, MD; José, E, Martínez, MD; Leandro, A, Heffner, MD; Andrea, Odzak, MD; Melisa, Dirchwolf, MD; Astrid, Smud, MD; Manuel, Mendizabal, MD; Carla, Bellizzi, MD; Ana, Martinez, MD; Jesica, Tomatis, MD; Andres, Bruno, MD; Agñel, Ramos, MD; Josefina, Pages, MD; Silvina, Tevez, MD; Adrian, C, Gadano, MD, PhD; and Diego, H, Giunta MD, PhD, have no relevant financial or non-financial interests to disclose.
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Marciano, S., Gutierrez-Acevedo, M.N., Barbero, S. et al. Norfloxacin prophylaxis effect on multidrug resistance in patients with cirrhosis and bacterial infections. Eur J Clin Microbiol Infect Dis 42, 481–491 (2023). https://doi.org/10.1007/s10096-023-04572-2
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DOI: https://doi.org/10.1007/s10096-023-04572-2