Risk factors forEnterobacteriaceaebacteremia after liver transplantation

Abstract

Summary Enterobacteriaceae are now the predominant pathogens isolated in bloodstream infections complicating orthotopic liver transplantation (OLT). We conducted a retrospective cohort study of patients who underwent OLT in a University hospital between 01/01/1997 and 31/03/2003 to investigate the risk factors of Enterobacteriaceae bacteremia (EB) after OLT. EB was defined as the isolation of an Enterobacteriaceae species from at least one blood culture within 3 months following OLT. Pre‐, per‐ and postoperative variables were collected from the medical records and analyzed in relation to EB. Forty (12.5%) of the 320 patients developed EB. The origin of EB was abdominal in 32% of the patients, urinary in 18%, pulmonary in 10%, and primary in the remaining 40% of the patients. Two‐thirds of EB occurred within 1 month following OLT. The main pathogens were Escherichia coli (42%), Enterobacter cloacae (17%) and Klebsiella pneumoniae (17%). Susceptibility rates varied from 82.5% for ciprofloxacin to 95% for amikacin. Fourteen patients (35%) with EB died. Variables significantly associated with EB after multivariate analysis were a MELD score >20 (OR: 2.79 [1.24–6.30], P = 0.013), transplantation for posthepatitic B (OR: 4.47 [1.67–11.98], P = 0.03) or posthepatitic C (OR: 3.79 [1.59–9.01], P = 0.03) cirrhosis, a positive bile culture (OR: 3.47 [1.19–10.13], P = 0.023) and return to surgery (including retransplantation) (OR: 2.72 [1.32–5.58], P = 0.006). EB is a frequent and severe complication following OLT. Patients grafted for a posthepatitic cirrhosis, with a severe pretransplantation status, with a positive bile culture and those undergoing reoperation have a high risk of developing EB.

Carbapenem‐resistant A cinetobacter baumannii acquired before liver transplantation: Impact on recipient outcomes

“…(25) In a univariate analysis, Hsieh et al (7) demonstrated that a high MELD score is a risk factor for A. baumannii infection after LT.…”

Living donor liver transplantation for end-stage liver disease with severe hepatopulmonary syndrome: Report of a case

“…To prevent septic graft loss high-risk patients with HPS should be transplanted with a low MELD score. 12 Although our patient had severe hypoxemia and a high shunt fraction, she had a low MELD score of 15 and no primary cardiopulmonary disease. Thus, she had "pure" HPS, which suggests that "pure" HPS with a low MELD score should respond well to LT, even if the hypoxemia is severe.…”

Enterobacteria Isolated From Synanthropic Flies (Diptera, Calyptratae) in Medellín, Colombia

“…3; Table 2). This suggests that the contact of the fly with food might be enough to produce contamination that causes an infection (Manrique & Delfín 1997), and may be associated with bacteremia, septicemia, intestinal infections and nosocomial diseases (Bellier et al 2008).…”