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Rifaximin in cirrhosis: Is its microbiological spotless record under threat?
Journal of Hepatology ( IF 26.8 ) Pub Date : 2024-12-16 , DOI: 10.1016/j.jhep.2024.11.033
Cornelius Engelmann

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.


中文翻译:


肝硬化中的利福昔明:其微生物一尘不染的记录是否受到威胁?


 部分片段

 背景和背景


由于免疫功能障碍和肠道屏障损伤,肝硬化患者特别容易受到感染和其他并发症的影响,导致抗生素的频繁使用和该人群中多重耐药 (MDR) 微生物的增加。[1], [2], [3] 在经常使用的抗菌剂中,利福昔明是一种肠道特异性抗生素,全身吸收最小,在预防复发性肝性脑病 (HE) 方面越来越受到重视。[4], [5], [6] 其


研究目的、方法和发现


Turner 等人最近在《自然》杂志上发表的研究 13 主要旨在揭示驱动万古霉素耐药屎肠球菌 (VREfm) 中达托霉素耐药的机制,重点关注未探索的基因组和表型因素。研究人员分析了来自澳大利亚的 717 株 VREfm 分离株,他们观察到 19.4% 的菌株表现出达托霉素耐药性。为了确定耐药机制,该团队筛选了 DAP 耐药和易感菌株的基因组。

 检查结果的意义


本研究强调了利福昔明使用和通过 rpoB 突变在 VREfm 中对最后手段抗生素产生交叉耐药性的交叉交叉问题。这些发现为潜在机制提供了令人信服的实验证据,但也提出了重大的悬而未决的问题,强调需要对临床意义和未来研究方向进行细致的评估。利福昔明暴露与 rpoB 介导的达托霉素耐药之间的关联是

 财务支持


作者没有获得任何经济支持来制作这份手稿。

 利益冲突


本研究的作者声明他们没有任何利益冲突。有关更多详细信息,请参阅随附的 ICMJE 披露表。
更新日期:2024-12-16
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