Surgical Site Infections After Liver Transplantation: Prospective Surveillance and Evaluation of 250 Transplant Recipients in Canada

Abstract

OBJECTIVE To evaluate the incidence of surgical-site infections (SSIs) in a cohort of liver transplant recipients and to assess risk factors predisposing patients to these infections. DESIGN Prospective observational cohort study. SETTING Single transplant center in Canada. PATIENTS Patients who underwent liver transplantation between February 2011 and August 2014. METHODS Multivariate logistic regression was used to identify independent risk factors for SSIs in liver transplant patients. RESULTS We enrolled 250 liver transplant recipients. The recipients' median age at the time of transplantation was 56 years (range, 19-70 years), and 166 patients (66.4%) were male. Moreover, 47 SSIs were documented in 43 patients (17.2%). Organ-space, superficial, and deep SSIs were noted in 29, 7, and 3 patients, respectively. In addition, 2 patients developed superficial and organ-space SSIs, and another 2 patients were found to have deep as well as organ-space infections. In total, we identified 33 organ-space SSIs (70.2%), 9 superficial SSIs (19.1%), and 5 deep SSIs (10.6%). Factors predictive of SSIs by multivariate analysis were duct-to-duct anastomosis (odds ratio [OR], 3.88; 95% CI, 1.85-8.13; P<.001) and dialysis (OR, 3.57; 95% CI, 1.02-12.50; P=.046). Of the 66 organisms isolated in both deep and organ-space SSIs, 55 (83%) were resistant to cefazolin. CONCLUSIONS Organ-space SSIs are a common complication after liver transplantation. Duct-to-duct anastomosis and dialysis were independent risk factors associated with SSIs. Appropriate perioperative prophylaxis targeting patients with duct-to-duct anastomosis and dialysis while simultaneously providing optimum coverage for the potential pathogens causing SSIs is warranted. Infect Control Hosp Epidemiol 2017;38:1084-1090.

Surgical site infection and risk factors following right lobe living donor liver transplantation in adults: A single‐center prospective cohort study

“…Incidence of reoperation ranges between 6% and 22.7%, and it was shown that reoperation is associated with SSI. Linuma et al showed in their study following living donor liver transplantation that reoperation is an independent risk factor for SSI. In our study, incidence of reoperation was 28.7%, including three retransplantation procedures, which is higher than the figures reported in the literature.…”

“…It was observed that the incidence of SSI secondary to biliary tract infections did not change depending on whether the type of anastomosis was duct‐to‐duct or Roux‐en‐Y hepaticojejunostomy . Yamamoto et al and Hollenbeak et al found that Roux‐en‐Y biliary reconstruction was an independent risk factor for SSI.…”

“…The reported incidence of surgical site infection (SSI) after a liver transplantation is high owing to the complexity of the surgical procedure, comorbidities, and immunosuppression (4%‐48%) . SSI causes decreased graft survival, prolonged hospital stay, increased costs, morbidity, and mortality . Various risk factors have been described for SSIs: obesity, diabetes mellitus, alcoholism, malnutrition, model for end‐stage liver disease (MELD) score, ABO incompatibility, preoperative anemia, low albumin levels, pretransplant abdominal infection, previous colonization by resistant microorganisms, intraoperative hyperglycemia, intraoperative blood transfusion, presence of vascular grafts, type of biliary anastomosis, retransplantation, cold ischemia time (CIT), biliary leak, and significant immunosuppression .…”

“…SSI causes decreased graft survival, prolonged hospital stay, increased costs, morbidity, and mortality . Various risk factors have been described for SSIs: obesity, diabetes mellitus, alcoholism, malnutrition, model for end‐stage liver disease (MELD) score, ABO incompatibility, preoperative anemia, low albumin levels, pretransplant abdominal infection, previous colonization by resistant microorganisms, intraoperative hyperglycemia, intraoperative blood transfusion, presence of vascular grafts, type of biliary anastomosis, retransplantation, cold ischemia time (CIT), biliary leak, and significant immunosuppression . The incidence of SSI has not changed in the last 10 years despite the advances in surgical techniques, improvements in postoperative treatments for liver transplant recipients, changes in immunosuppressive therapy, and the fact that organ allocation is performed according to the MELD scoring system .…”

Complicaciones en receptores de Trasplante Hepáti-co

“…(3,14) En cuanto a los agentes etiológicos, estos pueden ser virales, bacterianos, parasitarios y fúngicos (12). Las infecciones de espacio-órgano son el tipo más común de infecciones de sitio quirúrgico postoperatorias que se observan en receptores de trasplante hepático, y se menciona que su riesgo aumenta por la anastomosis de conducto a conducto y hemodiálisis antes del trasplante (9).…”