Bacterial and fungal infections after liver transplantation: An analysis of 284 patients

Wade, Jim; Rolando, Nancy; Hayllar, Karen M.; Philpott‐Howard, John; Casewell, M.W.; Williams, Roger

doi:10.1002/hep.1840210517

Cited by 258 publications

(162 citation statements)

References 18 publications

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“…Our data also confirm the importance of other previously reported risk factors for EBIs, such as biliary-enteric hepaticojejunostomy, early surgical graft complications, acute rejection, and early renal failure. [23][24][25] Although fluoroquinolones do not appear to be useful for SID in LTRs, other SID modalities, including The great majority of patients receiving glycopeptide prophylaxis also received antipseudomonal antibiotics. ‡…”

Section: Discussionmentioning

confidence: 99%

Selective intestinal decontamination with fluoroquinolones for the prevention of early bacterial infections after liver transplantation

et al. 2011

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The role of selective intestinal decontamination with fluoroquinolones (FQ-SID) in the prevention of early bacterial infections (EBIs) in liver transplant recipients (LTRs) is unknown. We used the online database of the Spanish Network of Infection in Transplantation/ Spanish Network for Research in Infectious Diseases, which prospectively analyzed 1010 LTRs from 12 Spanish hospitals from September 2003 to February 2005. We compared the incidence and etiology of EBIs (30 days after transplantation) in 415 LTRs from 4 centers that used FQ-SID (>7 days) and in 595 LTRs from 8 hospitals that did not use FQ-SID. A multivariate logistic regression analysis (including an adjustment for the transplant center factor) was performed to evaluate the potential protective factor of FQ-SID in the development of EBIs. We reported 266 EBI episodes in 252 LTRs (incidence ¼ 24.9%). There were no differences in the incidence of EBIs between patients in the FQ-SID group and patients not in the FQ-SID group [109/415 (26.3%) versus 143/595 (24%), P ¼ 0.9]. Although LTRs who received FQ-SID had a lower incidence of infections due to enteric bacteria (2.7% versus 6.5%, P ¼ 0.007) and a higher incidence of infections due to nonfermenting gram-negative bacilli (6.6% versus 2.6%, P ¼ 0.004), these findings could not be confirmed after an adjustment by the center factor in the multivariate models. We found no significant differences in the incidence of enterococcal infections (3.4% with FQ-SID versus 3.9% without FQ-SID, P ¼ 0.5). Multivariate analysis did not confirm any protective effect of FQ-SID against the development of EBIs by enteric bacteria. In conclusion, FQ-SID does not reduce the incidence of EBIs in LTRs and could be withheld from this group of patients. Liver Transpl 17:896-904,

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Section: Discussionmentioning

confidence: 99%

Selective intestinal decontamination with fluoroquinolones for the prevention of early bacterial infections after liver transplantation

et al. 2011

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“…In a previous study we documented episodes of bacterial infections, including those caused by AGNB, but did not provide any data on colonization. 9 In the present study we address the significance of acquisition of AGNB in clinical material in relation to infection. Although the analyses carried out in the present study failed to identify any pretransplantation factors that predisposed to acquisition of AGNB, patients who subsequently developed AGNB infections were more critically ill before transplantation, as evidenced by encephalopathy.…”

Section: Discussionmentioning

confidence: 99%

“…These patients were previously the subject of a detailed investigation of bacterial infection. 9 The present study concentrated on the significance of acquisition of AGNB in relation to infection. The range of patient ages was 16 to 69 years, and 156 (55%) were female.…”

Section: Methodsmentioning

confidence: 99%

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The significance of aerobic gram-negative bacilli in clinical specimens following orthotopic liver transplantation

1998

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In a prospective study of 284 liver transplant patients, we sought associations between aerobic gram-negative bacillus acquisition or infection and 35 preoperative, perioperative, and postoperative variables. Although the 128 (45%) who acquired aerobic gram-negative bacilli had longer admissions (P ‫؍‬ 0.0001), no associations were found with pretransplant variables. Fifty-three (41%) of the 128 acquired coliforms (e.g., Escherichia coli, Klebsiella spp., or Enterobacter spp.), 50 (39%) acquired nonfermentative bacilli (e.g., Acinetobacter spp., Pseudomonas spp., or Stenotrophomonas maltophilia), and a further 25 (20%) acquired both. Acquisition progressed to infection in 58% of patients who acquired coliforms but in only 18% of patients who acquired nonfermentative bacilli (P ‫؍‬ 0.005). Acinetobacter spp. were isolated from more patients than other bacilli but rarely caused infection. The positive predictive values for infection of acquiring coliforms or nonfermentative bacilli in clinical material were 42% and 17%, respectively. This study allowed us to determine for each clinical site the positive predictive values for infection of acquisition of different aerobic gram-negative bacilli. Our results should contribute to the rationalization of antimicrobial prescribing for this patient group.

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“…[71][72][73] In a report of liver transplant infections, one risk factor for fungal infection was described as ''prolonged therapy with ciprofloxacin.'' 74 Intermittent dosing, such as the following: 1) a single weekly dose of 750 mg of ciprofloxacin; 2) five doses of trimethoprim/sulfamethoxazole per week; or 3) restricting use of norfloxacin to inpatients only, with discontinuation of the drug at the time of discharge, may be the best compromises in preventing infection without selecting resistant flora, according to three randomized trials. [75][76][77] However, studies reporting substantial cost savings and/or survival advantages for treated patients will be required before prophylaxis can be enthusiastically recommended.…”

Section: Preventionmentioning

confidence: 99%

Management of adult patients with ascites caused by cirrhosis†

Runyon¹

1998

Hepatology

302

131

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Ascites is the most common of the major complications of cirrhosis. The development of ascites is an important landmark in the natural history of cirrhosis and has been proposed as an indication for liver transplantation. The initial evaluation of a patient with ascites should include a history, physical evaluation, and abdominal paracentesis with ascitic fluid analysis. Treatment should consist of abstinence from alcohol, sodium restricted diet, and diuretics. This regimen is effective in Ϸ90% of patients. The treatment options for the diuretic-resistant patients include serial therapeutic paracenteses, liver transplantation, and peritoneovenous shunting. (HEPATOLOGY 1998;27;264-272.) PREAMBLE These guidelines provide a data-supported approach to the care of patients with ascites. They are based on the following: 1) a formal review and analysis of the published world literature (1,045 papers) on ascites (Medline Search from 1966-1996, search terms included ascites, diet therapy, drug therapy, radiotherapy, surgery, and therapy); 2) the American College of Physician' s Manual for Assessing Health Practices and Designing Practice Guidelines 1 ; and 3) several published and draft guidelines, including the American Association for the Study of Liver Diseases' Policy Statement on Development and Use of Practice Guidelines and American Gastroenterological Association' s Policy Statement on Guidelines 2 ; and 4) 15 years of experience on the part of the author in the clinical and laboratory investigations of and care for patients with this problem.These guidelines, intended for use by physicians, suggest preferable approaches to the diagnostic, therapeutic, and preventative aspects of care. These guidelines are intended to be flexible, in contrast with ''standards of care,'' which are inflexible policies to be followed in almost every case. 1 Furthermore, these guidelines were developed for the care of adult patients with clinically detectable ascites. Although the general approach may be applicable to children, the pediatric data base is much smaller and there may be unanticipated differences between adults and children. Patients with ascites that is detected by imaging modalities alone, but not yet clinically evident, are not included because of the lack of published information regarding the natural history of this entity.Specific recommendations are based on relevant published information. In an attempt to standardize recommendations, the Practice Guidelines Committee of the American Association for the Study of Liver Diseases modified the categories of the Infectious Diseases Society of America' s Quality Standards. 3 These categories are reported with each recommendation, using the letters A through E to determine the strength of recommendation and roman numerals I through III to determine quality of evidence upon which recommendations are based, as follows: A, survival benefit; B, improved diagnosis; C, improvement in quality of life; D, relevant pathophysiologic parameters improved; E, impacts cost of heal...

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Bacterial and fungal infections after liver transplantation: An analysis of 284 patients

Cited by 258 publications

References 18 publications

Selective intestinal decontamination with fluoroquinolones for the prevention of early bacterial infections after liver transplantation

Selective intestinal decontamination with fluoroquinolones for the prevention of early bacterial infections after liver transplantation

The significance of aerobic gram-negative bacilli in clinical specimens following orthotopic liver transplantation

Management of adult patients with ascites caused by cirrhosis†

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