Early bacterial and fungal infections in liver transplantation after oral selective bowel decontamination

Hjortrup, A; Rasmussen, Allan; Hansen, Bent Adel; Høiby, Niels; Heslet, Lars; Moesgaard, F; Kirkegaard, Preben

doi:10.1016/s0041-1345(97)81730-7

Cited by 37 publications

(42 citation statements)

References 13 publications

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“…12 In contrast to most studies, Hjortrup and associates reported gram-positive bacteria as the predominant causative agents (67%) in post-LT infection. 13 In our study, the most common grampositive bacteria were Enterococcus species, of which vancomycin-resistant enterococci were the majority (74%), consistent with other reports from Iran. 14 Also, the same pattern of antimicrobial susceptibility (with a high rate of resistance among gram-negative bacteria) was reported in our previous study and others from Iran among patients who developed UTIs after kidney transplant and other hospitalized patients with UTIs, which were mainly nosocomial.…”

Section: Discussionsupporting

confidence: 91%

Untitled

Pouladfar¹,

Jafarpour²,

Firoozifar³

et al. 2017

Exp Clin Transplant

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Objectives: Urinary tract infections are among the most common infections after liver transplant, especially soon after surgery. This study analyzed urinary tract infections or bacteriuria, their causative agents, and related risk factors in the early period after liver transplant in hospitalized adult transplant recipients in the main liver transplant referral center in Iran. Results: Seventy-nine episodes of urinary tract infections or bacteriuria occurred in the infection group. Multiple logistic regression analysis showed that female sex, hospitalization 2 to 7 days before transplant, and frequency of abdominal exploration were 11.0, 5.9, and 3.0 times more common in the infection group than in the control group. The chance of infection rises 1.1 times with each one unit increase of body mass index. The most common infection causes were gram-negative bacteria (n = 50; 63.3%), predominantly Escherichia coli (n = 24; 30.4%); followed by gram-positive bacteria (n = 20; 25.3%), predominantly Enterococcus species (n = 14; 17.8%) that had a high incidence of vancomycin resistance (n = 10; 71.4%); and non-Candida albicans species isolates (n = 9; 11.4%). Conclusions: Urinary tract infections are a common infection in hospitalized adult patients soon after liver transplant. Female sex, hospitalization shortly before transplant, more frequent abdominal exploration, and higher body mass index substantially increased the risk of developing such infections in this period.

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Section: Discussionsupporting

confidence: 91%

Untitled

Pouladfar¹,

Jafarpour²,

Firoozifar³

et al. 2017

Exp Clin Transplant

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“…The data according to the Hjortrup study also showed a surgical site domination of Gram-positive bacteria (70.6 %) wherein coagulase-negative staphylococci and enterococci accounted for 66.6%. Gramnegative bacteria were found in 29.4%, and among them was a prevalence of Enterobacteriaceae (60%) [17].…”

Section: Discussionmentioning

confidence: 99%

Bacterial and Fungal Infections in the Early Post-transplantation Period After Liver Transplantation: Etiologic Agents and Their Susceptibility

Kawecki

Pacholczyk

Łągiewska

et al. 2014

Transplantation Proceedings

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“…The presence of secondary maxima in the time-concentration profiles of MPA after cessation of SBD as opposed to during SBD indicates that enterohepatic cycling of MPA was inhibited by SBD and restored when SBD was withdrawn. The contribution of these secondary maxima is reflected by a significant increase in AUC [6][7][8][9][10][11][12] . However, the secondary maximum never was very pronounced.…”

Section: Discussionmentioning

confidence: 99%

“…The antibiotic regimen used is not 100% efficient. 11 Because stool cultures were not performed, we cannot assume the sterility of feces during the regimen. However, direct interactions between MMF metabolism and the antibiotics are not expected, and any effect by SBD on the pharmacokinetics of MMF is likely to result from the proposed mechanism.…”

Section: Discussionmentioning

confidence: 99%

The effect of selective bowel decontamination on the pharmacokinetics of mycophenolate mofetil in liver transplant recipients

Schmidt

Rasmussen²,

Nørrelykke

et al. 2001

Liver Transplantation

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Mycophenolate mofetil (MMF) is a prodrug immunosuppressant with a high oral bioavailability. Enterohepatic cycling of a glucuronide derivative of MMF contributes substantially to the bioavailability, but is dependent on bacterial deglucuronidation by intestinal flora. This study aims to determine whether an antibiotic regimen with activity against such organisms reduces the bioavailability of MMF by impairing enterohepatic cycling. In a prospective trial, 6 liver transplant recipients were administered MMF and a 21-day antibiotic regimen for selective bowel decontamination (SBD). Time-concentration profiles of the pharmacologically active metabolite, mycophenolic acid (MPA), were obtained during and after the SBD regimen. The bioavailability of MPA was reduced during compared with after the regimen (14.5 ؎ 3.5 v 21.1 ؎ 9.8 mg ⅐ h/mL; P ‫؍‬ .07). The most pronounced contribution to this reduction was observed from 6 hours onward (2.4 ؎ 1.4 v 5.6 ؎ 4.4 mg ⅐ h/mL; P < .05). The presence of secondary maxima in the time-concentration profiles of MPA after, but not during, SBD indicates that enterohepatic cycling may be inhibited during SBD and restored afterward. Enterohepatic cycling may contribute 7% to 54% (mean, 29%) of the bioavailability of MPA. We conclude that the bioavailability of MMF may be reduced when SBD is used, and the reduction is likely to result from the interruption of enterohepatic cycling. This mechanism should be taken into consideration not only during SBD, but in any clinical setting combining MMF and broad-spectrum antibiotics. (Liver Transpl 2001;7: 739-742.)

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Early bacterial and fungal infections in liver transplantation after oral selective bowel decontamination

Cited by 37 publications

References 13 publications

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Bacterial and Fungal Infections in the Early Post-transplantation Period After Liver Transplantation: Etiologic Agents and Their Susceptibility

The effect of selective bowel decontamination on the pharmacokinetics of mycophenolate mofetil in liver transplant recipients

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