Norfloxacin prophylaxis effect on multidrug resistance in patients with cirrhosis and bacterial infections

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: NCT03919032Fil: Marciano, Sebastián. Hospital Italiano; ArgentinaFil: Gutierrez Acevedo, Maria N.. Hospital 4 de Junio; ArgentinaFil: Barbero, Sabrina. Complejo Medico Policial Bartolome Churruca Andres Visca; ArgentinaFil: del C. Notari, Lorena. Complejo Medico Policial Bartolome Churruca Andres Visca; ArgentinaFil: Agozino, Marina. Sanatorio Guemes; ArgentinaFil: Fernandez, Jose L.. Sanatorio Guemes; ArgentinaFil: Anders, Maria M.. Hospital Alemán; ArgentinaFil: Grigera, Nadia. Hospital Alemán; ArgentinaFil: Antinucci, Florencia. Hospital Alemán; ArgentinaFil: Orozco Ganem, Orlando F.. Hospital Aleman; ArgentinaFil: Murga, Maria D.. Hospital A. C. Padilla; ArgentinaFil: Perez, Daniela. Hospital A. C. Padilla; ArgentinaFil: Palazzo, Ana. Hospital A. C. Padilla; ArgentinaFil: Martinez Rejtman, Liria. Hospital Teodoro J. Schestakow; ArgentinaFil: Duarte, Ivonne G.. Hospital 4 de Junio; ArgentinaFil: Vorobioff, Julio. Hospital Provincial del Centenario; ArgentinaFil: Trevizan, Victoria. Hospital Provincial del Centenario; ArgentinaFil: Bulaty, Sofía. Hospital Provincial del Centenario; ArgentinaFil: Bessone, Fernando. Hospital Provincial del Centenario; ArgentinaFil: Valverde, Marcelo. Hospital de Clinicas Dr. Manuel Quintela; UruguayFil: Elizondo, Martín. Hospital de Clinicas Dr. Manuel Quintela; UruguayFil: Bosia, José D.. Hospital Prof. Rodolfo Rossi, la Plata; ArgentinaFil: Borzi, Silvia M.. Hospital Prof. Rodolfo Rossi, la Plata; ArgentinaFil: Stieben, Teodoro E.. Provincia de Entre Rios. Hospital San Martin; ArgentinaFil: Masola, Adriano. Provincia de Entre Rios. Hospital San Martin; ArgentinaFil: Ramos, Agñel. Sanatorio Parque; ArgentinaFil: Pages, Josefina. Universidad Austral; ArgentinaFil: Tevez, Silvina. Sanatorio Guemes; ArgentinaFil: Gadano, Adrián Carlos. Hospital Italiano; ArgentinaFil: Giunta, Diego Hernan. Hospital Italiano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin