Clinical

Risk factors for infection after liver transplantation identified

Last Updated: 2008-06-13 13:48:01 -0400 (Reuters Health)

NEW YORK (Reuters Health) - In a new study, Spanish researchers have identified several factors that are predictive of surgical site infections (SSIs) following orthotopic liver transplantation.

SSIs are a common problem after liver transplantation and in the current study were seen in 8.8% of patients, Dr. Antonio Ramos, from Hospital Universitario Puerta de Hierro in Madrid, and colleagues note. Roughly 10% of the SSIs were fatal. Most of the infections (42%) involved the surgical incision, followed closely by peritonitis (39%).

Gram-negative bacteria were the most commonly identified pathogens in this study of 1222 consecutive patients who underwent transplantation at 11 Spanish hospitals from August 2003 to September 2005. However, infections with gram-positive microbes, such as Enterococcus and Staphylococcus aureus, and even with fungal pathogens were also seen.

According to the report, which appears in the June issue of Liver Transplantation, choledochojejunal or hepaticojejunal reconstruction, previous liver or kidney transplant, and transfusion of more than 4 units of red blood cells all independently increased the odds of infection.

The risk of infection was also related to the antibiotic used for prophylaxis. In this regard, use of cefazolin carried the highest risk, the findings indicate. However, on multivariate analysis, the antibiotic used was not an independent risk factor.

In a related editorial, Dr. Shimon Kusne, from the Mayo Clinic Arizona, Phoenix, discusses the current findings and comments that several questions remain to be addressed, including what antibiotics are best for preventing post-transplantation SSIs, should combinations of antibiotics be used, should prophylaxis extend beyond 24 hours, and should prophylaxis be individualized based on risk factors.

Liver Transpl 2008;14:747-749,799-805.