{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T17:50:34Z","timestamp":1790704234625,"version":"4.1.0"},"reference-count":38,"publisher":"The Korean Association for the Study of the Liver","issue":"3","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"VA Merit Review","award":["I01CX002472"],"award-info":[{"award-number":["I01CX002472"]}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["NCATS UM1TR004360"],"award-info":[{"award-number":["NCATS UM1TR004360"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["e-cmh.org"],"crossmark-restriction":true},"short-container-title":["Clin Mol Hepatol"],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:p>Background\/Aims: Infections with drug-resistant organisms (DROs) are associated with poor outcomes in cirrhosis. Rifaximin, widely used for hepatic encephalopathy (HE), could promote cross-resistance, but data regarding clinical impact are conflicting. Aim: Determine predictors of DROs in a global cirrhosis inpatient cohort focusing on preadmission rifaximin use.Methods: From the global CLEARED consortium, we focused on cirrhosis inpatients with infections on\/during admission. Clinical\/demographic\/medication, especially rifaximin details were recorded. The primary outcome was DRO development. Multivariable regression for DRO including clinical, medications, and country income was performed.Results: 2,949 infected inpatients (55.3 years, 62.9% male) were included. 12.2% of all and 24.4% of culture-positive infections developed DROs; these patients had higher HE (39 vs. 31%, &lt;i&gt;P&lt;\/i&gt;=0.003), hepatorenal syndrome (25 vs. 19%, &lt;i&gt;P&lt;\/i&gt;=0.006), lactulose (55 vs. 47%, &lt;i&gt;P&lt;\/i&gt;=0.008) and rifaximin use (34 vs. 27%, &lt;i&gt;P&lt;\/i&gt;=0.006) on crude comparisons but country-income distributions were similar. 29.7% were on pre-admission rifaximin, mostly HE-related; they had more advanced cirrhosis and from low\/low-middle-income countries. Daptomycin was used in 1.5%, linked with DROs (5.0 vs. 1.0%, &lt;i&gt;P&lt;\/i&gt;&lt;0.0001) without a difference in rifaximin use (1.4 vs.1.7%, &lt;i&gt;P&lt;\/i&gt;=0.61). On adjusted analysis, MELD-Na (1.03, 95% CI 1.02\u20131.04, &lt;i&gt;P&lt;\/i&gt;&lt;0.001) increased, whereas male sex (0.73, 95% CI 0.58\u20130.92, &lt;i&gt;P&lt;\/i&gt;=0.008) and hepatitis-B (0.65, 95% CI 0.45\u20130.92, &lt;i&gt;P&lt;\/i&gt;=0.020) decreased DRO. Rifaximin was not associated with DROs overall (OR 1.07, 95% CI 0.80\u20131.43, &lt;i&gt;P&lt;\/i&gt;=0.65) or within income strata (high: 1.07, 95% CI 0.59\u20131.92, &lt;i&gt;P&lt;\/i&gt;=0.82, upper-middle: 1.18, 95% CI 0.74\u20131.85, &lt;i&gt;P&lt;\/i&gt;=0.49, low\/low-middle: 1.04, 95% CI 0.60\u20131.81, &lt;i&gt;P&lt;\/i&gt;=0.90) despite sensitivity analyses.Conclusions: In this large global cohort of hospitalized patients with cirrhosis and infections, 12% developed infections involving DROs. 30% had pre-admission rifaximin use which was not linked with daptomycin use or with DRO development on adjusted analysis overall or across country income groups.<\/jats:p>","DOI":"10.3350\/cmh.2026.0228","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T07:17:37Z","timestamp":1776237457000},"page":"1321-1332","update-policy":"https:\/\/doi.org\/10.3350\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Lack of association between rifaximin and drug-resistant infections: a global multicenter inpatient cirrhosis cohort"],"prefix":"10.3350","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4928-3681","authenticated-orcid":true,"given":"Jasmohan S.","family":"Bajaj","sequence":"first","affiliation":[{"name":"Department of Medicine, Virginia Commonwealth University and Richmond VA Medical Center, Richmond, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick S.","family":"Kamath","sequence":"additional","affiliation":[{"name":"Department of Medicine, Mayo Clinic School of Medicine, Rochesterc"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Toronto, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramazan","family":"Idilman","sequence":"additional","affiliation":[{"name":"Department of Medicine, Ankara University, Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Topazian","sequence":"additional","affiliation":[{"name":"Department of Medicine, St Paul Millenium Hospital, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wai-Kay","family":"Seto","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aldo","family":"Torre","sequence":"additional","affiliation":[{"name":"Department of Medicine, Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n Salvador Zubir\u00e1n, Mexico City, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Hayes","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Edinburgh, Edinburgh, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"George","sequence":"additional","affiliation":[{"name":"Department of Medicine, Storr Liver Centre, Westmead Millennium Institute, Westmead Hospital and University of Sydney, Sydney, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Alvares-da-Silva","sequence":"additional","affiliation":[{"name":"Department of Medicine, Hospital de Cl\u00ednicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian J.","family":"Bush","sequence":"additional","affiliation":[{"name":"Department of Population Health, Virginia Commonwealth University and Richmond VA Medical Center, Richmond"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Silvey","sequence":"additional","affiliation":[{"name":"Department of Population Health, Virginia Commonwealth University and Richmond VA Medical Center, Richmond"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashok","family":"Choudhury","sequence":"additional","affiliation":[{"name":"Department of Medicine, Institute for Liver and Biliary Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of CLEARED 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