Multidrug-Resistant Bacterial Infections before and after Liver Transplantation

Abstract

Bacterial infection represents a common event in the natural history of cirrhosis, especially in patients with end-stage liver disease. An episode of bacterial infection may significantly modify a patient's outcome in the setting of liver transplantation (LT) by impairing hepatic and extrahepatic organ functions, both in pre-operative and post-operative phases. Infections caused by multidrug-resistant organisms (MDRO) are increasing in cirrhosis due to high antibiotic exposure and hospitalizations. This issue is particularly important in the LT setting, where MDRO infections occurring before surgery and during the early days after surgery might significantly impair graft function and patient outcome. This review summarizes the recently published findings on the occurrence of MDRO infection before and after LT, and new perspectives for its prevention and treatment.

Epidemiology, Risk Factors and Outcome Due to Multidrug Resistant Organisms in Paediatric Liver Transplant Patients in the Era of Antimicrobial Stewardship and Screening

“…The incidence of MDRO infections has been increasing among LTR in the last decade [5,12,15,16,22,23]. We report a relatively lower prevalence of MDRO colonisation of 33% in our cohort of patients in contrast to 62%, 48%, and 45% reported by Phichaphop et al, Alcamo et al, and Beranger et al, respectively, in paediatric LTR [4,5,10].…”

“…MDRO has been reported to be associated with high mortality of 5-7% in paediatric LTR and 15-60% in adult LTR, in contrast to no mortality in our cohort [1,5,10,12,13]. Several adult and paediatric LTR studies have demonstrated that MDRO infections pretransplantation affects post-transplant survival [10,22]. GN-MDRO has been particularly associated with a higher morbidity and mortality in children and adult patients before and after transplant in comparison to GP-MDRO [3,11,15].…”