Intraoperative Versus Extended Antibiotic Prophylaxis in Liver Transplant Surgery: A Randomized Controlled Pilot Trial

Abstract

The appropriate duration of surgical antibiotic prophylaxis in orthotopic liver transplantation (OLT) in the presence of significant iatrogenic immunosuppression is unclear. We hypothesized that 72 hours of perioperative antibiotic prophylaxis would decrease rates of surgical site infection (SSI) in OLT patients when compared with intraoperative antibiotic prophylaxis alone. OLT recipients were randomized to receive either intraoperative antibiotics only (short antibiotics [SAs]) or 72 hours of perioperative antibiotics (extended antibiotics [EAs]). A total of 102 patients were randomized: 51 to the EA group and 51 to the SA group. Rates of SSI and nosocomial infection (NI) in the SA group were 19% and 17%, respectively, compared with 27% (SSI; P = 0.36) and 22% (NI; P = 0.47) in the EA group, although these differences were not statistically significant. Intensive care unit (ICU) length of stay (LOS), hospital LOS, 30‐day mortality, and time to infection were also similar between the 2 groups. Patients developing infections had longer ICU LOS and hospital LOS and a higher association with reoperation, endoscopic retrograde cholangiopancreatography, and 30‐day readmission. In conclusion, extending perioperative antibiotics to 72 hours from intraoperative dosing alone in OLT patients does not appear to decrease the incidence of SSI or NI. The results from this pilot trial with 60% power suggest that it is acceptable for OLT recipients to receive intraoperative antibiotic prophylaxis alone.

Perioperative antibiotics for preventing post-surgical site infections in solid organ transplant recipients

“…Allocation concealment was judged to be low risk in one study (Berry 2019). The risk of bias was unclear in the remaining seven studies.…”

“…Eight studies (718 randomised participants) were included in this review (Berry 2019;Cohen 1988;Evans 1988;Robles 1990;Townsend 1980;Wilms 1986).…”

“…Three studies (470 randomised participants) examined the e ect of extended antibiotics versus short course antibiotics in the prevention of surgical site infections in solid-organ transplant recipients (Berry 2019;. The intervention versus control arms were cefazolin every 12 hours or cefotaxime every 12 hours for three or five days, respectively, versus a single dose of cefazolin , three-day course of piperacillin/tazobactam every eight hours versus single dose of piperacillin/ tazobactam (Berry 2019), and ce riaxone and metronidazole versus ampicillin/sulbactam and cefazolin, although the duration of either therapy arms was not specified .…”

#Less Is More: Now Trending for Surgical Antibacterial Prophylaxis in Liver Transplantation

“…On the basis of the published literature demonstrating high SSI rates after LT and the perception that extended SAP will minimize risks, continuing SAP after LT is a common practice, although no studies have validated it. We applaud Berry et al for exploring this topic in a pilot study published in this issue of Liver Transplantation …”

“…We applaud Berry et al for exploring this topic in a pilot study published in this issue of Liver Transplantation. (5) This was a single-center, open-label, randomized controlled study comparing SSI rates in 2 SAP groups: short antibiotics (SAs) and extended antibiotics (EAs) with 51 first-time, nonhospitalized LT candidates enrolled in each group. Patients in both groups received 1 dose of intravenous antibacterials 30 minutes prior to incision.…”