Antibiotic prophylaxis for surgical site infection in people undergoing liver transplantation

Almeida, Ricardo Augusto Monteiro de Barros; Hasimoto, Cláudia Nishida; Kim, Anna; Hasimoto, Érica Nishida; Dib, Regina El

doi:10.1002/14651858.cd010164.pub2

Cited by 16 publications

(20 citation statements)

References 38 publications

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“…One of the most important strategies used to reduce PTIs is rational and appropriate use of prophylactic antibiotic regimen. 17 In this clinical trial, the combination of gentamicin and ampicillin-sulbactam was compared with the routine antibacterial prophylactic regimen in our center (ceftizoxime and ampicillin-sulbactam). The clinical effectiveness of gentamicin plus ampicillinsulbactam in preventing PTIs was significantly higher based on univariate analysis and its renal safety was comparable with the ceftizoxime plus ampicillin-sulbactam regimen.…”

Section: Discussionmentioning

confidence: 99%

<p>Comparison of Ceftizoxime Plus Ampicillin-Sulbactam versus Gentamicin Plus Ampicillin-Sulbactam in the Prevention of Post-Transplant Early Bacterial Infections in Liver Transplant Recipients: A Randomized Controlled Trial</p>

Shafiekhani

Karimzadeh

Nikeghbalian

et al. 2020

IDR

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In this study, we aimed to compare the efficacy of combined ceftizoxime with ampicillin-sulbactam versus combined gentamicin with ampicillin-sulbactam as prophylactic antibiotic regimen in preventing early bacterial PTIs in liver TX recipients at a referral center. Patients and methods: All patients older than 18 years who had undergone liver TX at Abu-Ali Sina transplantation center in Shiraz, Iran from July 2018 to April 2019 were included in this study. In a single-blinded manner, the participants randomly received either combined intravenous ceftizoxime plus ampicillin-sulbactam (ceftizoxime group) or gentamicin plus ampicillin-sulbactam (gentamicin group) as prophylactic antibiotic regimen before the incision of the surgery, which was continued for 48 hrs after liver Tx. The rate and type of bacterial infections, length of hospital and intensive care unit (ICU) stay, mortality rate, and kidney function were assessed during 1 month following liver TX in the two groups. Results: Two hundred and thirty patients were divided into two groups. One patient in the gentamicin group and five in the ceftizoxime group were excluded due to emergency exploratory laparotomy within the first 3 days after transplantation. The rate of bacterial infections during the first month after transplantation was 25.4%. This rate was significantly lower in the gentamicin group (13.16%) in comparison to the ceftizoxime group (38.18%) (P value<0.01), based on the univariate logistic regression analysis. Length of ICU and hospital stay and also mortality rate were significantly lower in the gentamicin group (P value <0.01). There was no significant difference regarding kidney function between the two groups (P value = 0.16). Conclusion: Our results suggested that gentamicin can be considered as a promising agent in prophylactic antibiotic regimen for patients undergoing liver TX. Trial registration: The study was registered at the Iranian Registry of Clinical Trials (IRCT20120731010453N2; http://www.irct.ir/).

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Section: Discussionmentioning

confidence: 99%

<p>Comparison of Ceftizoxime Plus Ampicillin-Sulbactam versus Gentamicin Plus Ampicillin-Sulbactam in the Prevention of Post-Transplant Early Bacterial Infections in Liver Transplant Recipients: A Randomized Controlled Trial</p>

Shafiekhani

Karimzadeh

Nikeghbalian

et al. 2020

IDR

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“…Several trials have evaluated perioperative antifungal and antiviral prophylaxis . Another trial has assessed the type of antimicrobial prophylaxis; however, there have been no studies comparing surgical prophylaxis duration and rates of postoperative infections in liver transplant patients, highlighting the dearth of evidence surrounding perioperative antibiotic prophylaxis in these patients . The present trial was performed to help clarify the evidence surrounding perioperative prophylaxis in first‐time OLT recipients.…”

Section: Discussionmentioning

confidence: 99%

“…Postoperative SSI occurs in up to 38% of first-time liver transplant recipients due to poor preoperative nutrition, comorbidities, intraoperative transfusions, long and complex operative cases, and postoperative immunosuppression. (1,13,18) Despite this high infectious complication rate, there is a paucity of data regarding antibiotic prophylaxis in OLT patients. Several trials have evaluated perioperative antifungal (19,20) and antiviral prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

“…(21,22) Another trial has assessed the type of antimicrobial prophylaxis (4) ; however, there have been no studies comparing surgical prophylaxis duration and rates of postoperative infections in liver transplant patients, highlighting the dearth of evidence surrounding perioperative antibiotic prophylaxis in these patients. (1,23,24) The present trial was performed to help clarify the Original article | 1051 evidence surrounding perioperative prophylaxis in first-time OLT recipients. This ambiguity is reflected in a recent survey of 60 liver transplant centers in Europe demonstrating highly variable perioperative dosing schedules for patients undergoing liver transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical site infections (SSIs) are a significant cause of morbidity and mortality in postsurgical patients, specifically following liver transplantation. (1) Historically, liver transplant recipients have a marked increase in rates of SSIs compared with other solid organ transplant patients, with rates ranging from 9% to 79% for all liver transplants and 18% to 38% in first-time transplant recipients. (1)(2)(3)(4)(5)(6)(7) This is also notably higher than general surgical cases, reported to be approximately 4%.…”

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confidence: 99%

See 2 more Smart Citations

Intraoperative Versus Extended Antibiotic Prophylaxis in Liver Transplant Surgery: A Randomized Controlled Pilot Trial

Berry

Rosenberger²,

Guidry

et al. 2019

Liver Transpl

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The appropriate duration of surgical antibiotic prophylaxis in orthotopic liver transplantation (OLT) in the presence of significant iatrogenic immunosuppression is unclear. We hypothesized that 72 hours of perioperative antibiotic prophylaxis would decrease rates of surgical site infection (SSI) in OLT patients when compared with intraoperative antibiotic prophylaxis alone. OLT recipients were randomized to receive either intraoperative antibiotics only (short antibiotics [SAs]) or 72 hours of perioperative antibiotics (extended antibiotics [EAs]). A total of 102 patients were randomized: 51 to the EA group and 51 to the SA group. Rates of SSI and nosocomial infection (NI) in the SA group were 19% and 17%, respectively, compared with 27% (SSI; P = 0.36) and 22% (NI; P = 0.47) in the EA group, although these differences were not statistically significant. Intensive care unit (ICU) length of stay (LOS), hospital LOS, 30‐day mortality, and time to infection were also similar between the 2 groups. Patients developing infections had longer ICU LOS and hospital LOS and a higher association with reoperation, endoscopic retrograde cholangiopancreatography, and 30‐day readmission. In conclusion, extending perioperative antibiotics to 72 hours from intraoperative dosing alone in OLT patients does not appear to decrease the incidence of SSI or NI. The results from this pilot trial with 60% power suggest that it is acceptable for OLT recipients to receive intraoperative antibiotic prophylaxis alone.

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Vacuum-assisted management of surgical site infections after liver transplantation: 15-year experience in a tertiary hepatobiliary center

et al. 2018

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Immune compromised as well as critically ill patients are at higher risk of surgical wound infection and dehiscence. Wound infections critically influence the outcomes after liver transplantation. In particular, it was shown that they significantly reduce the overall survival rate when compared to patients with uneventful wound healing, and their occurrence is associated with death or graft loss within 1-year post-transplantation. From January 2001 through December 2017, 763 patients underwent liver transplantation in our Institution, the Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, "Policlinico" University Hospital, University of Modena and Reggio Emilia, Modena, Italy. We retrospectively analyzed data from our prospectively maintained database of patients treated with a negative pressure therapy device due to wound or abdominal infections. 13 patients underwent negative pressure treatments for surgical site infection after liver transplantation in our institution. Ten superficial "supra-fascial" applications (SF group) and three deeper abdominal (Ab group) were reported. Mean in-hospital stay for the SF group was 42.6 days, ranging from 8 to 80, while for the Ab group was 62 days (range 23-133), with an overall survival of 34 and 4.6 months, respectively. A multifactorial multidisciplinary approach is needed in the prevention of surgical site infections instead of mere antimicrobial prophylaxis The application of negative pressure wound therapy may help in controlling the diffusion of the infection and preventing sepsis.

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Antibiotic prophylaxis for surgical site infection in people undergoing liver transplantation

Abstract: Antibiotic prophylaxis for surgical site infection in people undergoing liver transplantation.

Cited by 16 publications

References 38 publications

<p>Comparison of Ceftizoxime Plus Ampicillin-Sulbactam versus Gentamicin Plus Ampicillin-Sulbactam in the Prevention of Post-Transplant Early Bacterial Infections in Liver Transplant Recipients: A Randomized Controlled Trial</p>

<p>Comparison of Ceftizoxime Plus Ampicillin-Sulbactam versus Gentamicin Plus Ampicillin-Sulbactam in the Prevention of Post-Transplant Early Bacterial Infections in Liver Transplant Recipients: A Randomized Controlled Trial</p>

Intraoperative Versus Extended Antibiotic Prophylaxis in Liver Transplant Surgery: A Randomized Controlled Pilot Trial

Vacuum-assisted management of surgical site infections after liver transplantation: 15-year experience in a tertiary hepatobiliary center

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