Epidemiology and outcomes of surgical site infections among pediatric liver transplant recipients

Abstract

Introduction Surgical site infections (SSI) are a significant cause of morbidity in liver transplant recipients, and the current data in the pediatric population are limited. The goal of this study was to identify the incidence, classification, risk factors, and outcomes of SSIs among children undergoing liver transplantation (LT). Methods A single‐center, retrospective descriptive analysis was performed of patients age ≤18 years undergoing LT between September 2007 and April 2017. SSI identified within the first 30 days were analyzed. Primary endpoints included incidence, classification, risk factors, and outcomes associated with SSIs. Results We included 86 patients, eight patients (9.3%) developed SSIs. Among segmental grafts (SG) recipients, 7/61 (11.4%) developed SSI. Among whole grafts recipients, 1/25 (4%) developed SSI. SSIs were associated with the presence of biliary complications (35% vs. 3%, p < .01; odds ratios 24, 95% CI: 3.41‐487.37, p<.01). There were no differences in long term graft or patient survival associated with SSI. Patients who developed SSI were more likely to undergo reoperation (50% vs. 16.7%, p = .045) and had an increased total number of hospital days in the first 60 days post‐transplant (30.5 vs. 12.5 days, p = .001). Conclusions SSIs after pediatric LT was less frequent than what has been previously reported in literature. SSIs were associated with the presence of biliary complications without an increase in mortality. SG had an increased rate of biliary complications without an association to SSIs but, considering its positive impact on organ shortage barriers, should not be a deterrent to the utilization of SGs.

Surgical Site Infections After Pediatric Liver Transplantation—Impact of a Change in Perioperative Prophylactic Antibiotic Protocol

“…The same result was observed in our study, with recipients of deceased donor split grafts developing SSIs Surgical revisions, median (IQR) 0.5 (0-1) 1 (0-3) twice as often as recipients of whole or living donor grafts. According to literature, biliary complications are associated with SSIs [10,28]. Thus, SSIs might be effectively reduced by surgery technique, potentially including prevention bundles rather than single measures.…”

“…Bacterial infections like bloodstream infections, pneumonia, or surgical site infections (SSIs) are among the most frequent and severe complications after transplantation [10][11][12][13][14][15][16][17] and directly or indirectly cause about half of early postoperative deaths. SSIs occur in about a quarter of all transplant recipients with the clinical presentation ranging from superficial wound infections to intra-abdominal abscess, peritonitis, or infected necrosis leading to sepsis and requiring additional surgery.…”

“…SSIs occur in about a quarter of all transplant recipients with the clinical presentation ranging from superficial wound infections to intra-abdominal abscess, peritonitis, or infected necrosis leading to sepsis and requiring additional surgery. Observational studies and registries identified [10,12,18] multi-resistant bacteria (MRB) colonization, high-level immunosuppression, and insertion of an abdominal patch as risk factors for SSIs.…”

“…Time to SSI, median (IQR)19 12(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) Abbreviations: IQR, interquartile range; MDR, multidrug resistant; SSI, surgical site infections.…”

Risk Factors for Surgical-Site Infections After Liver Transplant: Does Perioperative Antibiotic Regimen Matter?

“…Some studies have demonstrated no association between SSIs and 60-d and 1-y mortality. 16,17 Others have demonstrated an association between SSIs and 1-y mortality, 18 and 1-y allograft loss. 18,19 Our study did not find an increased risk of mortality in those who developed SSIs after adjusting for suspected confounders.…”