Selective decontamination of the digestive tract in adult-to-adult living related liver transplant patients: a single centre experience

Venuti, Francesco S.; Panarello, Giovanna; Gruttadauria, Salvatore; Burgio, Giuseppe; Stefano, R. Di; Provenzani, A; Bavetta, S; Carollo, Antonella; Zampardi, V.; Cammarata, Sue; Sidoti, M.G.; Polidori, Piera; Castellese, M.; Gridelli, Bruno; Schillaci, D.; Johnson, Heather; Marsh, J.W.; Marcos, Amadeo

doi:10.1016/j.ijantimicag.2007.12.011

Cited by 3 publications

(3 citation statements)

References 7 publications

(6 reference statements)

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“…Of SDD trials of antifungals, most are either noncomparative or compare an SDD regimen to a historical cohort,41–47 employ two regimens utilizing the same antifungal,48 or compare different antifungals but without a placebo control 49, 50. Many fail to report the incidence of fungal infections,51–54 or report an extremely low incidence of fungal infections such that comparisons are not feasible,55 or report fungal infections but without providing a breakdown of fungal infections observed in each study arm.…”

Section: Clinical Studies Of Antifungal Prophylaxismentioning

confidence: 99%

Antifungal prophylaxis in liver transplant recipients

2009

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Although the overall incidence of fungal infections in liver transplant recipients has declined, these infections still contribute significantly to the morbidity and mortality of patients with risk factors for infection. Although antifungal prophylaxis has been widely studied and practiced, no consensus exists on which patients should receive prophylaxis, with which agent, and for what duration. Numerous studies have attempted to ascertain independent risk factors for invasive fungal infections in liver transplant patients, and these data, in addition to clinical trials, identify several patient groups at exceedingly high risk of fungal infection. These include retransplant patients, patients with renal failure requiring hemodialysis or renal replacement therapy, and those requiring reoperations after transplant. Because the majority of infections occur in the first month after transplantation, prophylaxis should be continued for 4-6 weeks. However, local epidemiology and research should guide decisions regarding choice of agent as well as overall development of interinstitutional guidelines, because the incidence and spectrum of infection may differ dramatically among institutions. Fungal infections are one of the most devastating infectious complications of liver transplantation, contributing significantly to both morbidity and mortality in these patients. 1 Management of invasive mycoses, particularly Aspergillus infections, has proven remarkably challenging. Of the 5%-40% of liver transplant patients who develop an invasive fungal infection (IFI), 2-4 mortality associated with these infections ranges from 25%-67%, 5 although Aspergillus-associated mortality is as high as 60%-90%. 4,6,7 A variety of factors, including environmental exposures, technical/anatomic issues, and the degree of immunosuppression present interact in the causation of fungal infection. 8 An understanding of these interactions and effects is vital for the assessment of risk for serious fungal infections after transplantation and the development of prophylactic strategies.

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Section: Clinical Studies Of Antifungal Prophylaxismentioning

confidence: 99%

Antifungal prophylaxis in liver transplant recipients

2009

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“…The UHN SDD preparation included colistin (polymyxin E) 10 mg/mL and gentamicin 8 mg/mL dissolved in 160 mL of water by the hospital pharmacy and administered to all LD‐LT recipients in the dose of 10 mL (total of colistin 100 mg + gentamicin 80 mg) orally 4 times a day, together with oral nystatin 500,000 U/5 mL suspension 4 times a day. For SDD in LD‐LT recipients, the prophylaxis was started per protocol 3 days before the surgery and continued until discharge or to a maximum of 14 days after LT if still in the hospital, similar to the practice described in the literature . SDD was routinely administered to every LD‐LT recipient until December 1, 2009 and discontinued thereafter.…”

Section: Methodsmentioning

confidence: 99%

“…In addition, several recent publications demonstrated a higher rate of severe bacterial infections after the LD‐LTs compared with deceased‐donor LTs (DD‐LTs) , suggesting that the potential benefit of SDD in LD‐LT might be greater than that for DD‐LT. Unfortunately, only one single‐center report describes a remarkably low incidence of postoperative infections in 53 adult LD‐LT recipients following use of SDD, but this study did not include a control or comparison group . Thus, data are limited on the use of this prophylactic strategy in LD‐LT recipients.…”

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confidence: 99%