Perioperative Antibiotic Prophylaxis to Prevent Surgical Site Infections in Solid Organ Transplantation

Abstract

Antibiotic prophylaxis in the perioperative period is the standard of care for nearly all surgical procedures and routinely prescribed during solid organ transplantation (SOT). The primary goal of perioperative antibiotic prophylaxis is to minimize postoperative surgical site infections (SSIs). SSIs are a significant issue in SOT. Depending on the organ transplanted, SSIs occur in 3% to 53% of patients, with the highest rates observed in small bowel/multivisceral, liver, and pancreas transplant recipients. SOT recipients are also at increased risk of developing SSIs with antimicrobial-resistant organisms. In this article, we describe the epidemiology and risk factors for SSIs in SOT and examine the available literature to guide the use of different regimens for perioperative antibiotic prophylaxis for each organ. We have further addressed specific situations that are unique to each organ transplant type, such as the use of extracorporeal membrane oxygenation in thoracic organ transplantation, as well as an approach to perioperative antibiotic prophylaxis in the setting of recipient and/or donor infection before transplantation. We provide potential approaches to the selection, dosing, and duration of perioperative antibiotic prophylaxis for each of these clinical situations.

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

“…This results in significant interinstitutional variation in the choice of SAP agent and duration. (4) 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.…”

“…SAP is routinely indicated in liver transplantation (LT), but its use warrants attention because published data for SAP in this setting are limited with existing guidelines making little or no mention of transplant‐specific procedures. This results in significant interinstitutional variation in the choice of SAP agent and duration . 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.…”

“…Although questions remain regarding drug choice, this trial was not intended to detect the influence of different antibiotics on outcomes. Although the investigators used P/T for standard prophylaxis, other agents with varying spectrums of antimicrobial activity have been previously studied . Antibiotic selection should consider institutional microbial epidemiology and may need to be individualized for patients colonized with multidrug‐resistant organisms.…”

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

“…One prevention strategy for reducing SSIs includes perioperative antimicrobial prophylaxis. Organisms commonly causing SSIs in OLT patients include Enterobacteriaceae , Acinetobacter , Pseudomonas , Enterococcus , and Staphylococcus aureus . Therefore, regimens covering these microorganisms are recommended.…”

“…Organisms commonly causing SSIs in OLT patients include Enterobacteriaceae, Acinetobacter, Pseudomonas, Enterococcus, and Staphylococcus aureus. (14) Therefore, regimens covering these microorganisms are recommended. For the general surgery population, both the CDC and WHO recommend cessation of antibiotics upon closure of the surgical site, but it can be extended up to, but no longer than, 24 hours afterward.…”