Bacterial infections in the early period after liver transplantation in adults: A prospective single‐center cohort study

Abstract

Liver transplantation (LT) is a potentially curative treatment for terminal stage hepatic diseases. Bacterial infections are the main causes of mortality and morbidity in the early period after LT. Identifying the risk factors could help in minimizing their development. We prospectively investigated the incidence, characteristics, and risk factors of bacterial infections among the recipients during hospitalization after LT and assigned a predictive score. All 389 consecutive adults who underwent LT at the main referral hospital of LT in Iran during 1 year were enrolled prospectively in a cohort study. Infection group consisted of 143 recipients (36.8%). Urinary tract and surgical site infections were the most frequent ones. Gram-negative bacteria were more prevalent than Gram-positive ones. Independent risk factors were female sex (relative risks = 2.13), age ≤ 43.5 years (3.70), hospital stay ≥ 9.5 days (5.22), abdominal reoperation (3.03), vancomycin-resistant Enterococci colonization (5.52), hospitalization 3 months prior to LT (3.25), mechanical ventilation ≥48 hr (4.93), and renal replacement therapies (13.40). We developed a risk score for the prediction of bacterial infections with an area under the receiver operating characteristic curve of 0.85 (95% CI, 0.81-0.89) with sensitivity of 88% and specificity of 64%. In the infection group, mortality was higher than in controls (18.9% vs. 2.0%) with longer hospitalization (16 vs. 10 days; P < 0.001). We detected a high rate of bacterial infections leading to longer hospital stay and higher mortality rate. The formulated risk score can help predict bacterial infections; however, it requires clinical validation in further studies. K E Y W O R D S bacterial infections, Iran, liver transplantation, risk factors, scoring systems ---Abbreviations: AUC, area under the curve; CRRT, continuous renal replacement therapy; LT, liver transplantation; MDR, multidrug resistance; MELD, model for end-stage liver disease; ROC curve, receiver operating characteristic curve. | RESULTSDuring the study period, 399 LTs were performed on 389 adult patients. Ten (2.6%) patients received two transplants each: seven for post-transplant complications, two 408 | JAFARPOUR ET AL.

Early post‐liver transplantation infections and their effect on long‐term survival

“…4 Other influential factors that may serve as confounders might stem from the hosts themselves, reflecting a greater tendency toward infections of specific individuals. [20][21][22] Another interesting finding is the direct correlation between the number of infectious events per patient and long-term survival: whereas the presence of any infection within 30 days or within 6 months post-LT did not affect survival in our cohort, every additional infection was associated with a significant increase in mortality rate. This finding suggests that the "burden of infection," rather than the infection itself is the major contributor to the long-term impact on patients' survival.…”

Bacterial and fungal co-infections with SARS-CoV-2 in solid organ recipients: a retrospective study

“…The majority of VRE infections occur in pre-colonized patients [35]. In a previous evaluation of pre-transplant patients in our center 9% were colonized with VRE [36]. Furthermore, the majority of the isolated Candida species were of the non-albicans type (80%).…”

Bacterial and Fungal Co-infections with SARS-CoV-2 in Solid Organ Recipients, A Retrospective Study

“…The majority of VRE infections occur in pre-colonized patients (34). In a previous evaluation of pre-transplant patients in our center 9% were colonized with VRE (35). Furthermore, the majority of the isolated Candida species were of the non-albicans type (80%).…”