Surgical Site Infection in Liver Transplant Recipients: Impact of the Type of Perioperative Prophylaxis

Prado, María E. García; Cordero, Elisa; Ciuró, Felipe Pareja; Díez-Canedo, J. Serrano; Martín, J. Martínez; López, Francisco M. Porras; Casa, Ángel Cantos de la; Cisneros, José Miguel

doi:10.1097/tp.0b013e3181735407

Cited by 66 publications

(58 citation statements)

References 27 publications

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“…(1, 11, 19, 21, 35, 58, 63-76) Five studies reported rates of intra-abdominal abscess, with a combined incidence 0.044 (95% CI = 0.019 to 0.078). Six studies reported rates of surgical site infection (Pooled proportion of 0.118 (95% CI = 0.054 to 0.202)).…”

Section: Resultsmentioning

confidence: 99%

A meta-analysis of complications following deceased donor liver transplant

McElroy¹,

Daud²,

Davis³

et al. 2014

The American Journal of Surgery

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Background Liver transplantation is a complex surgery associated with high rates of postoperative complications. While national outcomes data are available, national rates of most complications are unknown. Data Sources A systematic review of the literature reporting rates of postoperative complications between 2002 and 2012 was performed. A cohort of 29,227 deceased donor liver transplant recipients from 74 studies was used to calculate pooled incidences were for 17 major postoperative complications. Conclusions This is the first comprehensive review of postoperative complications after liver transplantation and can serve as a guide for transplant and non-transplant clinicians. Efforts to collect national data on complications, such as through the National Surgical Quality Improvement Program, would improve the ability to provide patients with informed consent, serve as a tool for individual center performance monitoring, and provide a central source against which to measure interventions aimed at improving patient care.

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Section: Resultsmentioning

confidence: 99%

A meta-analysis of complications following deceased donor liver transplant

McElroy¹,

Daud²,

Davis³

et al. 2014

The American Journal of Surgery

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“…After LT, bacterial infections occur in 35%–70% of patients; these infections are predominantly caused by Enterobacteriaceae ( 10 – 13 ). Although recent studies from Spain and China have reported alarmingly high rates of ESBL production in isolates from LT recipients ( 14 – 16 ), to our knowledge, the epidemiology of ESBLE infections among these high-risk patients in a nonepidemic setting has not been investigated.…”

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confidence: 99%

Pretransplant Fecal Carriage of Extended-Spectrum β-Lactamase–producingEnterobacteriaceaeand Infection after Liver Transplant, France

Bert

Larroque²,

Paugam–Burtz³

et al. 2012

Emerg. Infect. Dis.

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Bacterial infection after liver transplant is fairly common, mostly because liver transplant patients are severely ill and the surgery is very complex. Adding to the seriousness of this situation is that some bacteria are resistant to many antimicrobial drugs. However, treating all infections as drug resistant would lead to even more drug resistance, so only patients at highest risk should receive the most powerful drugs. But who is at highest risk? A recent study in France screened fecal samples of liver transplant candidates and found that post-operative infections were most likely for those patients who already had certain bacteria in their feces before surgery. Thus, fecal screening for those multiresistant bacteria should be considered for all liver transplant candidates so that if post-operative infection develops, those at high risk can receive the most specific drugs right away.

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“…The operative site is the leading anatomic site of infections in recipients of liver transplantation (LT) . Surgical site infections (SSIs), as defined by the Centers for Disease Control and Prevention, have been reported to follow 11% to 34% of LT procedures, and they have been associated with an increased risk of graft loss and death . Risk factors associated with SSIs in these investigations have included pretransplant antibiotic therapy, pretransplant mechanical ventilation, intraoperative hyperglycemia, intraoperative administration of vasopressors, need for intraoperative red blood cell transfusions, surgeons, and operative times …”

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Surgical site infections after liver retransplantation: Incidence and risk factors

Shah

Hellinger²,

Heckman

et al. 2014

Liver Transpl

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Surgical site infections (SSIs) after liver transplantation (LT) are associated with an increased risk of graft loss and death. The incidence of SSIs after LT and their risk factors have been determined for first LT but not for second LT. The importance of reporting the incidence of SSIs risk-stratified by first LT versus second LT is not known. All patients undergoing second LT at a single institution between 2003 and 2011 (n 5 152) were reviewed. The Kaplan-Meier method was used to estimate the cumulative SSI incidence. Relative risks (RRs) and 95% confidence intervals (CIs) from Cox proportional hazards regression models were used to evaluate associations of potential risk factors with SSIs after second LT. Thirty-one patients developed SSIs (6 superficial SSIs, 1 deep SSI, and 24 organ/space SSIs). The cumulative incidence of SSIs 30 days after LT was 20.8% (95% CI 5 14%-27%), which was slightly but not significantly higher than the previously reported incidence of SSIs after first LT at our institution between 2003 and 2008 (16%, RR 5 1.32, 95% CI 5 0.90-1.93, P 5.16). Units of transfused red blood cells [RR (doubling) 5 1.38, 95% CI 5 1.02-1.86, P 5.04] and hepaticojejunostomy (RR 5 2.22, 95% CI 5 1.05-4.72, P 5.04) were the only factors associated with SSIs after second LT in single-variable analysis. The associations weakened in a multivariate analysis (P 5.07 and P 5.07, respectively), potentially because of the correlation of red blood cell transfusions and hepaticojejunostomy (P 5.08). In conclusion, the incidence of SSIs after second LT was slightly higher but not significantly different than the published incidence of SSIs (16%) after first LT at the same institution. Significant independent risk factors for SSIs after second LT were not identified. Risk stratification for retransplantation may not be necessary when the incidence of SSIs after LT is being reported. Liver Transpl 20:930-936, 2014. V C 2014 AASLD.Received December 13, 2013; accepted April 11, 2014.The operative site is the leading anatomic site of infections in recipients of liver transplantation (LT).1 Surgical site infections (SSIs), as defined by the Centers for Disease Control and Prevention, have been reported to follow 11% to 34% of LT procedures, 2-5 and they have been associated with an increased risk of graft loss and death.6 Risk factors associated with SSIs in these investigations have included pretransplant antibiotic therapy, pretransplant mechanical ventilation, intraoperative hyperglycemia, intraoperative administration of vasopressors, need for intraoperative red blood cell transfusions, surgeons, and operative times. 2,3,5,6 Feedback about benchmarked, risk-adjusted rates of SSIs to surgeons has been associated with declines in the rates of these infections in nontransplant surgeries.7-10 An appropriate risk adjustment of SSI incidence is required for the identification of modifiable factors that are associated with the development of SSIs and for the feedback of credible information to surgeons. Published reports of ...

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Surgical Site Infection in Liver Transplant Recipients: Impact of the Type of Perioperative Prophylaxis

Cited by 66 publications

References 27 publications

A meta-analysis of complications following deceased donor liver transplant

A meta-analysis of complications following deceased donor liver transplant

Pretransplant Fecal Carriage of Extended-Spectrum β-Lactamase–producingEnterobacteriaceaeand Infection after Liver Transplant, France

Surgical site infections after liver retransplantation: Incidence and risk factors

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