Researchers determine risk factors for infection after liver transplantation

Nearly 9 percent of patients who recently underwent liver transplantation suffered a subsequent surgical site infection (SSI). Risk factors included having had biliary-enteric anastomosis (choledocho-jejunal or hepatic-jejunal reconstruction), previous liver or kidney transplant, and more than four red blood cell units transfused. These findings are published in the June issue of Liver Transplantation, a journal by John Wiley & Sons.

SSIs are common after liver transplantation and are a major cause of morbidity and mortality. They result from the technical complexity of the procedure, the fact that it occurs within a potentially infected area of the body and the poor medical condition of many recipients. Researchers aimed to determine the incidence, timing, location and risk factors, including antibiotic prophylaxis, for such infections.

They designed a prospective study that included 1,222 consecutive patients who received liver transplants in 11 Spanish hospitals between August 2003 and September 2005. They included all infections that developed up to six months after surgery, including both wound incisional and organ/space infection, hepatic and intra-abdominal abscess, and peritonitis. To assess risk factors for surgical site infections, they looked at patients who became ill in the first 30 days after their surgery. They then examined possible risk factors for their infections.

SSIs occurred in 8.8 percent of patients, most within the first few weeks after the transplant. About 10 percent of these were fatal, which is a great improvement over the past. The predominant infection site was the incision (42 percent) while 39 percent of infections were peritonitis; 16 percent intraabdominal abscess and 10 percent hepatic abscess.

Most infections were caused by gram-negative aerobic bacteria, which are inhabitants of the digestive tract. Infection risk was related to choice of antibiotic prophylaxis, with the highest risk seen with the use of cefazolin. Fungal infection occurred in 10 cases, a remarkably high number because many of the participant institutions used fluconazole.

After multivariate analysis, the authors found that, biliary-enteric anastomosis, previous liver or kidney transplant, and more than four red blood cell units transfused were independently associated with the development of SSIs.

The results provide insight into the risk of SSIs in relation to previous transplantation, choledocho-jejunal reconstruction and red blood cell transfusion which could motivate new studies to aid the understanding of pathogenesis if SSI in liver transplantation.

An accompanying editorial considers the history of liver transplantation and the new study by Asensio and colleagues within the context of the literature on SSIs.

It concludes that bacterial prophylaxis should be used in liver transplantation in order to decrease surgical site infections. The agent or agents should provide therapeutic concentration not only in the wound, but also within the biliary tract where anastomosis is created. Randomized trials are needed to determine the optimal antibiotic therapy to prevent surgical site infections after liver transplantation.

Source: Wiley-Blackwell

Related stories:

Virus weaves itself into the DNA transferred from parents to babies
Parents expect to pass on their eye or hair color, their knobby knees or their big feet to their children through their genes. But they don't expect to pass on viruses through those same genes.
Early treatment is key to combating hepatitis C virus
Canadian researchers have shown that patients who receive early treatment for Hepatitis C virus (HCV) within the first months following an infection, develop a rapid poly-functional immune response against HCV similar to when infection is erradicted spontaneously, according to a new study published in the Journal of Virology. Therefore, early treatment can restore immune response against HCV and help eliminate the virus rapidly. This new discovery of the mechanisms of viral eradication could contribute to the development of new treatments.
Drug abuse accounts for a third of the deaths behind Scotland's higher mortality rate
Drug abuse accounts for a third of the deaths behind Scotland's higher mortality rate, according to a study published on bmj.com today.
Disclosure of organ transplant risks: A question of when, not if
University of Pennsylvania School of Medicine physicians and bioethicists are calling for a new, more standardized way for patients in need of organ transplants to be informed of the risks they face. If adopted, their policy recommendations could promote greater equity in how organs are allocated while restricting patients' abilities to "cherry-pick" the best organs.
Feta cheese made from raw milk has natural anti-food-poisoning properties
Eating Feta cheese made from raw milk in small seaside tavernas when you are on holiday in Greece could be a good way to combat food poisoning, according to researchers speaking today at the Society for General Microbiology’s 162nd meeting being held this week at the Edinburgh International Conference Centre.
Monkey malaria widespread in humans and potentially fatal
A potentially fatal species of malaria is being commonly misdiagnosed as a more benign form of the disease, thereby putting lives at risk, according to research funded by the Wellcome Trust and the University Malaysia Sarawak.
Mouse model shows potential efficacy of HIV prevention strategy
A new kind of laboratory mouse can be used to test the efficacy of much-needed methods to prevent transmission of HIV, the virus that causes AIDS, according to research by J. Victor Garcia and colleagues at the University of Texas Southwestern Medical Center in Dallas.
Existing antiretroviral drugs may thwart vaginal HIV transmission, researchers report
Prescription drugs now used to treat human immunodeficiency virus infection in adults may prevent the vaginal transmission of HIV, researchers at UT Southwestern Medical Center have found.

News discussion:

Medicine & Health news