Risk factors for development of surgical site infections among liver transplantation recipients: An integrative literature review

Oliveira, Ramon Antônio; Turrini, Ruth Natália Teresa; Poveda, Vanessa de Brito

doi:10.1016/j.ajic.2017.05.021

Cited by 25 publications

(15 citation statements)

References 34 publications

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“…Thus, using the entire cohort, a form of recursive partitioning called classification and regression tree (CART) analyses was performed. Variables identified as risk factors for SSI in this patient population by a previous review of the literature 8 were used to build the CART model. The CART method was used to separate patients into different homogeneous risk groups and to determine risk of SSI.…”

Section: Methodsmentioning

confidence: 99%

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A Retrospective Cohort Study of Risk Factors for Surgical Site Infection Following Liver Transplantation

Oliveira

Mancero²,

Faria³

et al. 2019

Prog Transpl

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Background: Surgical site infection is an important complication in the postoperative period among liver transplant recipients. However, little is known about the risk factors in this patient group. Therefore, the objective of this study was to analyze the incidence and risk factors for surgical site infections among adult liver transplant recipients. Methods: Medical records of adult liver transplant recipients from January 1, 2009, to December 31, 2015, were analyzed in this retrospective cohort study. Results: We enrolled 156 recipients' medical records. Forty-two (26.9%) cases of surgical site infections were identified. The main isolated microorganisms were methicillin-resistant Staphylococcus species, extended spectrum b-lactamase-producing Klebsiella species, carbapenem-resistant Pseudomonas aeruginosa, carbapenem-resistant Acinetobacter baumannii, and vancomycin-susceptible Enterococcus faecalis. We found that long operative times (487 minutes) and differences in body mass index between donor and recipient (1.3 kg/m 2) increased the risk for surgical site infections by approximately 5 times (odds ratio [OR], 5.5; 95% confidence interval [CI], 2.5-11.8), and capillary glycemia 175 mg/dL in the first 96 postoperative hours increased the risk by approximately 3 times (OR, 2.97; 95% CI, 1.43-6.17). Conclusions: There was a high incidence of surgical site infections among the studied population and that some risk factors identified differ from those reported in the scientific literature.

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Section: Methodsmentioning

confidence: 99%

“…[5][6][7] Additionally, a recent review of the scientific literature noted that uncertainties remain about risk factors for SSI among liver transplant recipients, although the topic has been widely investigated. 8 Thus, this study aimed to analyze the incidence and risk factors for SSI among adult liver transplant recipients.…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Cohort Study of Risk Factors for Surgical Site Infection Following Liver Transplantation

Oliveira

Mancero²,

Faria³

et al. 2019

Prog Transpl

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“…Transfusion is an independent risk factor for SSI in other surgical specialties, 97,39,98 and it has been strongly suggested to similarly be a risk factor in adult spine surgery. There exists some conflict in the literature to date, with a majority of studies finding a significant increase in SSI associated with transfusion, 4,5,28,61,79,89,93 but others finding it not to be of significance.…”

Section: Surgery-associated Risk Factorsmentioning

confidence: 99%

Surgical Site Infection in Spine Surgery: Who Is at Risk?

Yao

Zhou

Choma

et al. 2018

Global Spine Journal

105

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Study Design:Retrospective literature review of spine surgical site infection (SSI).Objective:To perform a review of SSI risk factors and more specifically, categorize them into patient and surgical factors.Methods:A review of published literature on SSI risk factors in adult spine surgery was performed. We included studies that reported risk factors for SSI in adult spinal surgery. Excluded are pediatric patient populations, systematic reviews, and meta-analyses. Overall, we identified 72 cohort studies, 1 controlled-cohort study, 1 matched-cohort study, 1 matched-paired cohort study, 12 case-controlled studies (CCS), 6 case series, and 1 cross-sectional study.Results:Patient-associated risk factors—diabetes mellitus, obesity (body mass index >35 kg/m2), subcutaneous fat thickness, multiple medical comorbidities, current smoker, and malnutrition were associated with SSI. Surgical associated factors—preoperative radiation/postoperative blood transfusion, combined anterior/posterior approach, surgical invasiveness, or levels of instrumentation were associated with increased SSI. There is mixed evidence of age, duration of surgery, surgical team, intraoperative blood loss, dural tear, and urinary tract infection/urinary catheter in association with SSI.Conclusion:SSIs are associated with many risk factors that can be patient or surgically related. Our review was able to identify important modifiable and nonmodifiable risk factors that can be essential in surgical planning and discussion with patients.

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“…Living donor liver transplantation is a life‐saving procedure for end‐stage liver disease. The reported incidence of surgical site infection (SSI) after a liver transplantation is high owing to the complexity of the surgical procedure, comorbidities, and immunosuppression (4%‐48%) . SSI causes decreased graft survival, prolonged hospital stay, increased costs, morbidity, and mortality .…”

Section: Introductionmentioning

confidence: 99%

Surgical site infection and risk factors following right lobe living donor liver transplantation in adults: A single‐center prospective cohort study

Aktaş

Kayaalp

Güneş

et al. 2019

Transplant Infectious Dis

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Introduction:Surgical site infection (SSI) is an important cause of decreased graft survival, prolonged hospital stay, and higher costs following living donor liver transplantation. There are several risk factors for SSI. In this cohort study, we aimed to investigate the incidence of SSI at our center and the associated risk factors. Materials and Methods: Adult right lobe living donor liver transplantations were included in this prospective cohort. Patients who died postoperatively within 3 days; patients with infected ascites or open abdomen, cadaveric, or pediatric transplants;and patients with biologic or cryopreserved vascular grafts were excluded. Patients' demographic characteristics and perioperative surgical findings were recorded. SSI follow-up was continued for 90 days. CDC-2017 criteria were used to diagnose SSI. In the presence of superficial, deep, and organ/space SSI, only the organ in the poorest condition was included in SSI evaluation. The patients were administered similar to antibiotic prophylaxes and immunosuppressive protocols.Results: A total of 101 patients were enrolled in this study, of which 30 (29.7%) were diagnosed with SSI. Organ/space, only deep, and only superficial SSI were noted in 90% (27/30), 6.7% (2/30), and 3.3% (1/30) of the patients, respectively. Twenty-five of 30 patients with SSI had a remote site infection. One or more bacteria observed in cultures were obtained from 28 patients. A donor-recipient age difference of >10 years, cold ischemia lasting for ≥150 minutes, surgical duration of ≥600 minutes, intraoperative hemorrhage of ≥1000 mL, intraoperative blood transfusion, biliary leak or stricture, prolonged mechanical ventilation, prolonged intensive care unit and hospital stay, remote site infection, and the need for reoperation were associated with increased SSI incidence. Preoperative and intraoperative levels of blood glucose, albumin, and hemoglobin were not associated with SSI. A donor-recipient age difference of >10 years, remote site infection, and biliary leak were found to be independent risk factors for SSI. Hospital mortality with and without SSIs was 6.7% vs 4.4%, P = .61.

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Risk factors for development of surgical site infections among liver transplantation recipients: An integrative literature review

Cited by 25 publications

References 34 publications

A Retrospective Cohort Study of Risk Factors for Surgical Site Infection Following Liver Transplantation

A Retrospective Cohort Study of Risk Factors for Surgical Site Infection Following Liver Transplantation

Surgical Site Infection in Spine Surgery: Who Is at Risk?

Surgical site infection and risk factors following right lobe living donor liver transplantation in adults: A single‐center prospective cohort study

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