Effect of antibiotic prophylaxis on the risk of surgical site infection in orthotopic liver transplant (original) (raw)
Related papers
American Journal of Transplantation, 2007
Information describing the incidence and clinical characteristics of late infection (LI) in solid organ transplantation (SOT) is scarce. The aim of this study was to define the incidence, clinical characteristics and risk factors for LI (>6 months) as compared with infection in the early period (<6 months) after SOT. By the online database of the Spanish Network of Infection in Transplantation (RESITRA) we prospectively analyzed 2702 SOT recipients from September 2003 to February 2005. Univariate and multivariate analysis using logistic regression were performed to calculate the risk factors associated with the development of LI. A total of 131 patients developed 176 LI episodes (8%). Global incidence of LI was 0.4 per 1000 transplant-days, ranging from 0.3/1000 in kidney transplants to 1.4 in lung transplants. Independent risk factors for LI in were: acute rejection in the early period (OR 1.5; CI 95%: 1.1–2.3), chronic graft malfunction (OR 2; CI 95%: 1.4–3), re-operation (OR 1.9; CI 95%: 1.3–2.8) relapsing viral infection apart from CMV (OR 1.9; CI 95%: 1.1–3.5), previous bacterial infection (OR 1.8; CI 95%: 1.2–2.6) and lung transplantation (OR 4.5; CI 95%: 2.6–7.8). Severe LI occurs in a subgroup of high-risk SOT recipients who deserve a more careful follow-up and could benefit from prolonged prophylactic measures similar to that performed in the early period after transplantation.
Infection in Organ Transplantation: Risk Factors and Evolving Patterns of Infection
Infectious Disease Clinics of North America, 2010
The evolution of immunosuppression for organ transplantation has reduced the incidence of acute graft rejection but has increased the risk for infection and virally mediated malignancie 1-6 The clinical diagnosis of infection is complicated by the relative absence of signs and symptoms of inflammation, alterations in anatomy caused by transplantation surgery, denervation of grafts, and underlying diseases such as diabetes or cirrhosis. Several noninfectious causes of fever (graft rejection, drug reactions, autoimmune disorders) may mimic infection. Established infection is poorly tolerated in transplant recipients with a high level of associated morbidity. Equally important, the toxicities and interactions of antimicrobial agents with the standard immunosuppressive agents used to prevent graft rejection are often amplified because of underlying organ dysfunction. As a result, early and specific microbiologic diagnoses and rapid treatment of infections are essential. Advanced radiologic techniques and invasive diagnostic procedures may be required to establish firm microbiologic diagnoses. The relatively recent availability of quantitative molecular and antibody-based diagnostic assays has facilitated such early diagnoses and these are now used routinely in transplant infectious disease management.
Surveillance of perioperative infections after adult living donor liver transplantation
Transplantation Proceedings, 2004
Aim. This study was conducted to clarify the management of perioperative infectious complications after adult living donor liver transplantation (LDLT). Patients and Methods. Fourteen adult LDLT patients were enrolled in this study. We examined the occurrence of infectious complications in these cases and the relationships of infectious complications to UNOS status and MELD score. Surveillance culture and immunoserologic analyses were performed. From the results of these analyses, we made a diagram of infection surveillance using a matrix of time and sampling site. Using the diagram, we chose sensitive antibiotics as soon as possible.
Infections in liver and lung transplant recipients: a national prospective cohort
European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2018
Infections are a major complication of solid organ transplants (SOTs). This study aimed to describe recipients' characteristics, and the frequency and etiology of infections and transplant outcome in liver and lung SOTs, and to investigate exposures associated to infection and death in liver transplant recipients. The study population included recipients of SOTs performed in Italy during a 1-year period in ten Italian lung transplant units and eight liver transplant units. Data on comorbidities, infections, retransplantation, and death were prospectively collected using a web-based system, with a 6-month follow-up. The cumulative incidence of infection was 31.7% and 47.8% in liver and lung transplants, respectively, with most infections occurring within the first month after transplantation. Gram-negatives, which were primarily multidrug-resistant, were the most frequent cause of infection. Death rates were 0.42 per 1000 recipient-days in liver transplants and 1.41 per 1000 reci...
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.