Early Intra-Abdominal Bacterial Infections after Orthotopic Liver Transplantation: A Narrative Review for Clinicians

Abstract

Despite recent advances in the transplant field, infectious complications after orthotopic liver transplantation (OLT) are major causes of morbidity and mortality. Bacterial intra-abdominal infections (IAIs) are predominant during the first month post-transplantation and affect patient and graft survival. Recently, the emergence of multidrug resistant bacteria has generated great concern in OLT patients. We performed this narrative review of the literature in order to propose a “ready-to-use” flowchart for reasoned empirical antibiotic therapy in the case of suspected post-OLT IAIs. The review was ultimately organized into four sections: “Epidemiology and predisposing factors for IAI”; “Surgical-site infections and perioperative prophylaxis”; “MDRO colonization and infections”; and “Reasoned-empirical antibiotic therapy in early intra-abdominal infections post OLT and source control”. Multidisciplinary teamwork is warranted to individualize strategies for the prevention and treatment of IAIs in OLT recipients, taking into account each patient’s risk factors, the surgical characteristics, and the local bacterial epidemiology.

Role of a Real-Time TDM-Based Expert Clinical Pharmacological Advice Program in Optimizing the Early Pharmacokinetic/Pharmacodynamic Target Attainment of Continuous Infusion Beta-Lactams among Orthotopic Liver Transplant Recipients with Documented or Suspected Gram-Negative Infections

“…The median [interquartile range (IQR)] age was 57 years (51-63 years), with a male preponderance (63.6%). The Median (IQR) Model for End-Stage Liver Disease was 17 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). In seven cases (9.1%), DCD was implemented.…”

“…Several studies have shown that Gram-negative infections have a major role during the early post-OLT period, with pneumonia, bacteremia, and intrabdominal infections being the most frequent ones [1,[4][5][6][7][8][9][10][11]20,21]. In this scenario, beta-lactams are first-line treatments [12], and attaining an optimal PK/PD target early may allow for the maximization of clinical efficacy and suppress resistance development with beta-lactams [17,18].…”

The role of gut barrier dysfunction in postoperative complications in liver transplantation: pathophysiological and therapeutic considerations

“…Preexisting gut barrier dysfunction in patients with ESLD is further aggravated by the complex and long-time operational procedure and its associated I/R injury. Therefore, the bacterial translocation process is promoted during LT surgery and in the postoperative period, contributing to infectious complications [ 58 ]. In a prospective longitudinal study with LT patients, evaluating endotoxin concentrations in the perioperative period, patients with post-LT infectious complications had significantly higher endotoxin levels before LT and at the 14 postoperative day compared with those without complications [ 32 ].…”

Pharmacokinetic/pharmacodynamic issues for optimizing treatment with beta-lactams of Gram-negative infections in critically ill orthotopic liver transplant recipients: a comprehensive review

“…To this regard, it is noteworthy to highlight that in critically ill OLT recipients some specific features are most likely reported compared with general intensive care unit (ICU) patients. Specifically, intra-abdominal and/or biliary infections are prevalent among critically ill OLT recipients, and may account for up to 50% of early infections occurring after OLT (Van Delden, 2014;Taddei et al, 2023).…”

“…Specifically, hospitalacquired pneumonia (HAP), ventilator-associated pneumonia (VAP), bloodstream infections (BSIs), surgical site infections, and biliary/intra-abdominal infections are those most frequently reported (Weiss et al, 2010;Ikegami et al, 2012;Karapanagiotou et al, 2012;Patel and Huprikar, 2012;Van Delden, 2014;Antunes et al, 2015;Laici et al, 2018;Chueiri Neto et al, 2019;Massa et al, 2019;Wu et al, 2022). The prevalence of the different causative pathogens may greatly vary among the different transplant centers worldwide (Patel and Huprikar, 2012), but that of Gram-negatives is worryingly increasing nowadays (Patel and Huprikar, 2012;Giannella et al, 2023;Taddei et al, 2023). Unfortunately, most of these may be multidrug-resistant (MDR) or difficult-to-treat resistant (DTR) pathogens, and this pattern of resistance may affect clinical outcome, and cause prolonged antibiotic treatment (Patel and Huprikar, 2012).…”