The significance of aerobic gram-negative bacilli in clinical specimens following orthotopic liver transplantation

Abstract

In a prospective study of 284 liver transplant patients, we sought associations between aerobic gram-negative bacillus acquisition or infection and 35 preoperative, perioperative, and postoperative variables. Although the 128 (45%) who acquired aerobic gram-negative bacilli had longer admissions (P ‫؍‬ 0.0001), no associations were found with pretransplant variables. Fifty-three (41%) of the 128 acquired coliforms (e.g., Escherichia coli, Klebsiella spp., or Enterobacter spp.), 50 (39%) acquired nonfermentative bacilli (e.g., Acinetobacter spp., Pseudomonas spp., or Stenotrophomonas maltophilia), and a further 25 (20%) acquired both. Acquisition progressed to infection in 58% of patients who acquired coliforms but in only 18% of patients who acquired nonfermentative bacilli (P ‫؍‬ 0.005). Acinetobacter spp. were isolated from more patients than other bacilli but rarely caused infection. The positive predictive values for infection of acquiring coliforms or nonfermentative bacilli in clinical material were 42% and 17%, respectively. This study allowed us to determine for each clinical site the positive predictive values for infection of acquisition of different aerobic gram-negative bacilli. Our results should contribute to the rationalization of antimicrobial prescribing for this patient group.

Risk factors forEnterobacteriaceaebacteremia after liver transplantation

“…These results are concordant with a previous report studying the significance of aerobic Gram‐negative bacilli in clinical specimens after OLT [30]. Among 284 patients undergoing OLT, only nine (3%) demonstrated a positive bile culture growing an Enterobacteriaceae species.…”

The effect of surgical site infections on outcomes and resource utilization after liver transplantation

“…Preoperative infections are significant sources of morbidity, mortality, and resource utilization among orthotopic liver transplant recipients. 5,6,[29][30][31] In this study of 777 first, single organ transplant recipients from the NIDDK Liver Transplantation Database, we found that transplant recipients who develop surgical site infections had a significantly higher rate of graft loss, accumulated more than 24 additional hospital days, and incurred approximately $131,000 in excess charges. As noted previously, these excess charges represent 1995 dollars.…”

“…4 However, infectious complications remain a substantial problem after OLT. [5][6][7] Liver transplant recipients are particularly susceptible to infection. The surgical procedure itself is complex and can take many hours, even in the best of hands, and has the potential for contamination via the gastrointestinal tract.…”

Stenotrophomonas maltophilia bacteremia after living donor liver transplantation: Report of a case

“…2 It is associated with signifi cant morbidity and mortality rates because it shows a resistance to almost all the currently available antibiotics.…”