Rifaximin in cirrhosis: Is its microbiological spotless record under threat?

Abstract

Section snippets

Background and context

Patients with cirrhosis are particularly vulnerable to infections and other complications due to immune dysfunction and intestinal barrier impairment, leading to frequent antibiotic use and an associated rise in multidrug-resistant (MDR) organisms in this population.[1], [2], [3] Among the antimicrobials frequently employed, rifaximin, a gut-specific antibiotic with minimal systemic absorption, has gained prominence for the prevention of recurrent hepatic encephalopathy (HE).[4], [5], [6] Its

Objectives, methods, and findings

The recently published study in Nature by Turner et al.¹³ primarily aimed to uncover the mechanisms driving daptomycin resistance in vancomycin-resistant Enterococcus faecium (VREfm), focusing on unexplored genomic and phenotypic factors. Researchers analyzed a collection of 717 VREfm isolates from Australia, where they observed that 19.4% of the strains exhibited daptomycin resistance. To identify resistance mechanisms, the team screened the genomes of DAP-resistant and susceptible strains.

Significance of findings

This study highlights an emerging issue at the intersection of rifaximin use and the development of cross-resistance to a last resort antibiotic in VREfm via rpoB mutations. The findings present compelling experimental evidence about the potential mechanism but also raise significant unanswered questions, emphasizing the need for a nuanced evaluation of clinical implications and future directions in research.The association between rifaximin exposure and rpoB-mediated daptomycin resistance is

Financial support

The author did not receive any financial support to produce this manuscript.

Conflict of interest

The author of this study declares that they do not have any conflict of interest.Please refer to the accompanying ICMJE disclosure form for further details.