Surveillance of perioperative infections after adult living donor liver transplantation (original) (raw)
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Transplant infectious disease : an official journal of the Transplantation Society, 2018
Infectious complications represent one of the main causes of perioperative morbidity and mortality of liver transplant recipients. The primary objective of this retrospective observational study was to evaluate incidence and etiology of early (within 1 month from surgery and occurring in the intensive care unit [ICU]) postoperative infections as well as donor- and recipient-related risk factors. The data of 280 patients undergoing 299 consecutive liver transplant procedures from January 2012 to December 2015 were extracted from the Italian ICU registry database and hospital registries. Perioperative risk factors, etiology of infections, and antibiotic susceptibility of isolated microorganisms were taken into consideration. Global incidence of postoperative infections was 21%. Pneumonia was the most frequent infection and, globally, gram-negative bacteria were the most common agents. Septic shock was present in 22% of infection cases and hospital mortality was higher in patients with...
Liver Transplantation, 2013
In recipients of liver transplantation (LT), surgical site infection (SSIs) are among the most common types of infection occurring in the first 60 days after LT. In 2007, the Model for End-Stage Liver Disease (MELD) scoring system was adopted as the basis for prioritizing organ allocation. Patients with higher MELD scores are at higher risk for developing SSIs as well as other health care-associated infections. However, there have been no studies comparing the incidence of SSIs in the pre-MELD era with the incidence in the period since its adoption. Therefore, the objectives of this study were to evaluate the incidence, etiology, epidemiology, and outcomes of post-LT SSIs in those 2 periods and to identify risk factors for SSIs. We evaluated all patients who underwent LT over a 10-year period (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011). SSI cases were identified through active surveillance. The primary outcome measure was an SSI during the first 60 days after LT. Risk factors were analyzed via logistic regression, and 60-day survival rates were evaluated via Cox regression. We evaluated 543 patients who underwent LT 597 times. The SSI rates in the 2002-2006 and 2007-2011 periods were 30% and 24%, respectively (P 5 0.21). We identified the following risk factors for SSIs: retransplantation, the transfusion of more than 2 U of blood during LT, dialysis, cold ischemia for >400 minutes, and a cytomegalovirus infection. The overall 60-day survival rate was 79%. Risk factors for 60-day mortality were retransplantation, dialysis, and a longer surgical time. The use of the MELD score modified the incidence and epidemiology of SSIs only during the first year after its adoption. Risks for SSIs were related more to intraoperative conditions and intercurrences after LT than to a patient's status before LT.
Infection is a common cause of morbidity and mortality after liver transplantation, which are often caused by Gram negative bacteria and the most frequently occurring infectious complications after liver transplantation (LT). The aim of this study was to investigate, incidence, pathogenic spectrum, and risk factors for bacteria due to multidrug resistant (MDR) Gram-negative bacteria, and its impact on mortality after LT. In total, 150 consecutive patients who underwent liver transplantation between January 2012 and March 2013, 115 isolates of bacteria and 10 isolates fungal from 80 patients. MicroScan® microbiology and API20 were used to identify the all isolates. Bacterial infections represented the most frequent event (92.0%) and fungal infections (8.0%). The presumed sources of infection were the Urine (41 events, 51%), followed by the bail drain (14 events, 17.5%). Infections of the sputum, ascetic fluid, and blood site accounted for 13.8, 5.0 and 6.3%, respectively. Antibiotics the most susceptible antibiotic against Pseudomonas aeruginosa was colistin (94.1%). Patients with Gramnegative bacilli after liver transplantation show a significantly worse prognosis. Gram-negative bacteria after liver transplantation have been a major problem in our center.
The Impact of Postoperative Infection on Long-Term Outcomes in Liver Transplantation
Transplantation Proceedings, 2010
Introduction. Postoperative infection (POI) prolongs inpatient stay, delays return to normal activity, and may be detrimental to long-term survival after cancer resections. This study sought to identify the impact of postoperative infection on liver transplantation outcomes. Methods. We analyzed our prospective database of 910 adult patients who underwent liver transplantation between 2000 and 2010 in a single UK center. POI was defined as pyrexia plus positive cultures from blood, sputum, urine, wound, or ascitic fluid. Patient demographic features and perioperative variables were analyzed for their effects on POI. The impacts of POI on overall survival (OS) and graft survival were analyzed using Kaplan-Meier curves with log-rank tests for significance, before entry into a multivariate regression analysis. We analyzed the effects of POI on the length of hospital stay (LOS) and the incidence of acute rejection episodes and readmissions within 1 year as secondary outcomes.
Advances in Clinical and Experimental Medicine
Background. Healthcare-associated infections could affect the rate of morbidity, mortality and postdischarge hospitalization among patients. They are also dangerous to healthcare professionals and generate significant cost to the healthcare system. Objectives. The aim of this study was to evaluate the occurrence rate of colonization with various antibioticresistant (AR) bacteria among patients admitted to the Department of Immunology, Transplantology and Internal Diseases. Material and methods. The study used retrospective analysis of patients (n = 280) with no clinical signs of infection admitted into the department between November 2015 and May 2017. The observational period lasted until January 2019. Collected data included sex, age at admission, location directly prior to current hospitalization, and medical history. Nasal and rectal swabs were collected, and stool and urine samples were obtained on the day of admission. Specimens were cultured according to standard microbiological procedures. In all cases, the appropriate bioMerieux (Marcy-l'Étoile, France) media were used. Isolates were identified using mass spectrometer (Vitek MS; bioMerieux). Results. One-hundred ninety-one (68.2%) of patients were colonized with AR bacteria. The incidence of colonization was not influenced by age or sex. The risk of colonization was associated with admission from another hospital and history of kidney transplantation (p = 0.0136 and p < 0.001, respectively). The number of hospitalizations during the whole observational period was higher in the group of colonized patients compared to non-colonized (2.76 ±2.4 vs 2.07 ±1.68, p = 0.0099). The number of hospitalizations correlated positively with the number of positive cultures obtained from the same patients (rho = 0. 18, p = 0.0274). Conclusions. The rate of colonization at admission to the ward could be high, depending on previous hospitalization and medical history. Colonization significantly increased post-discharge hospitalization rate.
Multidrug-resistant bacterial infection in solid organ transplant recipients
Enfermedades Infecciosas y Microbiología Clínica, 2012
The most frequent complication from infection after solid organ transplantation is bacterial infection. This complication is more frequent in organ transplantation involving the abdominal cavity, such as liver or pancreas transplantation, and less frequent in heart transplant recipients. The sources, clinical characteristics, antibiotic resistance and clinical outcomes vary according to the time of onset after transplantation. Most bacterial infections during the first month post-transplantation are hospital acquired, and there is usually a high incidence of multidrug-resistant bacterial infections. The higher incidence of complications from bacterial infection in the first month post-transplantation may be associated with high morbidity. Of special interest due to their frequency are infections by S. aureus, enterococci, Gram-negative enteric and non-fermentative bacilli. Opportunistic bacterial infections may occur at any time on the posttransplant timeline, but are more frequent between months two and six, the period in which immunosuppression is higher. The most frequent bacterial species causing opportunistic infections in organ transplant recipients are Listeria monocytogenes and Nocardia spp. After month six, posttransplantation solid organ transplant patients usually develop conventional community-acquired bacterial infections, especially urinary tract infections by E. coli and S. pneumoniae pneumonia. In this article we review the clinical characteristics, epidemiology, diagnosis and prognosis of bacterial infections in solid organ transplant patients.
Perioperative Bacterial Infections in Deceased Donor and Living Donor Liver Transplant Recipients
Journal of clinical and experimental hepatology, 2012
Background: Deceased donor (DDLT) and living donor (LDLT) liver transplant (LT) is in vogue in several centers in India. Most centers are resorting to LDLT as a preferred surgery due to shortage of deceased donor liver. The risk of infection and its effect on survival in both groups of recipients from the Indian subcontinent are not known. The study was conducted to compare the bacterial infection rates among LDLT and DDLT recipients and their impact on survival at a tertiary referral center. Methods: Retrospective data on 67 LT recipients were reviewed. Data on pre-, per-, and postoperative bacterial infection rates and the common isolates were obtained. Results: Thirty-five patients had LDLT and 32 had DDLT. The prevalence of pre-operative bacterial infection and the isolates was similar in both groups. The perioperative bacterial infection rates were significantly higher in DDLT recipients (P < 0.01) (relative risk: 1.44 95% confidence interval 1.04-1.9). In both LDLT and DDLT, the common source was urinary tract followed by bloodstream infection. The common bacterial isolates in either transplant were Klebsiella followed by Escherichia coli, Pseudomonas spp. and nonfermenting gram-negative bacteria. Six patients (four LDLT; two DDLT) were treated for tuberculosis. Among the risk factors, cold ischemic time, and duration of stay in the intensive care unit was significantly higher for DDLT (P < 0.01). The death rates were not significantly different in the two groups. However, the odds for death were significantly high at 26.8 (P < 0.05) for postoperative bacterial infection and 1.8 (P < 0.001) for past alcohol. Conclusion: Liver transplant recipients are at high-risk for bacterial infection irrespective of type of transplant, more so in DDLT.
Influence of multi drug resistance Gram negative bacteria in liver transplant recipient
African journal of microbiology research
Infection is a common cause of morbidity and mortality after liver transplantation, which are often caused by Gram negative bacteria and the most frequently occurring infectious complications after liver transplantation (LT). The aim of this study was to investigate, incidence, pathogenic spectrum, and risk factors for bacteria due to multidrug resistant (MDR) Gram-negative bacteria, and its impact on mortality after LT. In total, 150 consecutive patients who underwent liver transplantation between January 2012 and March 2013, 115 isolates of bacteria and 10 isolates fungal from 80 patients. MicroScan® microbiology and API20 were used to identify the all isolates. Bacterial infections represented the most frequent event (92.0%) and fungal infections (8.0%). The presumed sources of infection were the Urine (41 events, 51%), followed by the bail drain (14 events, 17.5%). Infections of the sputum, ascetic fluid, and blood site accounted for 13.8, 5.0 and 6.3%, respectively. Antibiotics...