Perioperative Chemoprophylaxis οr Treatment for Extensively Drug Resistant Gram-Negative Bacteria in Patients Undergoing Liver Transplantation Based on Preoperative Donor/Recipient Surveillance Cultures: A Prospective Study

E Massa; E Michailidou; S Papadopoulos; D Agapakis; I Kotsamidi; D Xarisopoulos; E Iosifidis; M Daoudaki; D Philis; G Imvrios; E Vagdatli; D Vasilakos; V Papanikolaou; I Fouzas; E Mouloudi

doi:10.1016/j.transproceed.2019.01.077

Perioperative Chemoprophylaxis οr Treatment for Extensively Drug Resistant Gram-Negative Bacteria in Patients Undergoing Liver Transplantation Based on Preoperative Donor/Recipient Surveillance Cultures: A Prospective Study

Transplant Proc. 2019 Mar;51(2):457-460. doi: 10.1016/j.transproceed.2019.01.077. Epub 2019 Jan 28.

Authors

E Massa¹, E Michailidou², S Papadopoulos², D Agapakis², I Kotsamidi², D Xarisopoulos², E Iosifidis³, M Daoudaki⁴, D Philis⁴, G Imvrios⁴, E Vagdatli⁵, D Vasilakos⁶, V Papanikolaou⁴, I Fouzas⁴, E Mouloudi²

Affiliations

¹ Intensive Care Unit, Hippokratio General Hospital, Thessaloniki, Greece. Electronic address: elenizioga@yahoo.com.
² Intensive Care Unit, Hippokratio General Hospital, Thessaloniki, Greece.
³ Infectious Diseases Section, 3rd Department of Pediatrics, Hippokratio General Hospital, Medical School Aristotle University of Thessaloniki, Thessaloniki, Greece.
⁴ Division of Transplantation, Department of Surgery, Hippokratio General Hospital, Medical School Aristotle University of Thessaloniki, Thessaloniki, Greece.
⁵ Biopathology Laboratory Unit, Hippokratio General Hospital, Thessaloniki, Greece.
⁶ Anesthesiology Department, University Hospital "AHEPA," Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece.

PMID: 30879566
DOI: 10.1016/j.transproceed.2019.01.077

Abstract

Introduction: The importance of preoperative donor/recipient colonization or donor infection by extensively drug-resistant Gram-negative bacteria (XDR-GNB) and its relation to serious post-transplantation infection pathogenicity in liver transplantation (LT) patients has not been clarified.

Aim: Prevention of postoperative infection due to XDR-GNB with the appropriate perioperative chemoprophylaxis or treatment based on preoperative donor/recipient surveillance cultures in LT patients, as well as their outcome.

Materials and method: Twenty-six patients (20 male, 6 female) were studied (average preoperative Model for End-Stage Liver Disease score ≈15, range: 8-29) from January 2017 to January 2018. In all patients, blood, urine, and bronchial secretions culture samples as well as a rectal colonization culture were taken pre- and postoperatively, once weekly after LT, and after intensive care unit discharge. Recipients with positive XDR-GNB colonization and patients receiving a transplant from a donor with an XDR-GNB positive culture or colonization received the appropriate chemoprophylaxis one half hour preoperatively according to culture results. De-escalation of the antibiotic regimen was done in 2 to 5 days based on the colonization/culture results of the donor and recipient and their clinical condition. Evaluation for serious infection was done at 1 week and at 28 days for outcome results.

Results: Fourteen out of 26 recipients (53.8%) were positive for XDR-GNB colonization preoperative, with 2/14 (14.28%) presenting serious infection due to the same pathogen. Intensive care unit length of stay was significantly longer in colonized with XDR-GNB patients (P < .0001). The outcome of colonized patients was 6/14 (42.8%) expired, but only in 2/14 (14.2%) was mortality attributable to infection.

Conclusion: Administering appropriate perioperative chemoprophylaxis and treatment may limit the frequency of XDR-GNB infections and intensive care unit length of stay and may improve the outcome in LT recipients.

MeSH terms

Adult
Anti-Bacterial Agents / therapeutic use
Antibiotic Prophylaxis / methods*
Female
Gram-Negative Bacteria
Gram-Negative Bacterial Infections / immunology*
Gram-Negative Bacterial Infections / prevention & control*
Humans
Immunocompromised Host*
Liver Transplantation*
Male
Middle Aged
Prospective Studies
Tissue Donors

Substances

Anti-Bacterial Agents