Background: The most common pathogens seen in early post LT intraabdominal and bloodstream infection are enterococci, staphylococci and aerobic gram negative bacilli and perioperative prophylaxis is recommended targeted to these pathogens. In our center, we have historically used only a third generation cephalosporin for perioperative prophylaxis. There was a clinical perception of high rates of infections due to enterococcus, including VRE, that prompted this study.

Objective: To determine the rate and describe the pathogens involved in bacteremia and intraabdominal infections (IAI) within 30 days following adult LT in our center from January 2008 to December 2012.

Methods: A retrospective chart review was conducted of all adult LT recipients was conducted. Data collected included age, gender, primary diagnosis, donor type and MELD at transplant. The microbiology laboratory database was then used to define patients with any positive cultures from blood or sterile intraabdominal collection. The isolate and antimicrobial susceptibility pattern was recorded.

Results: There was a total of 275 LT recipients in this time. Of these, 85 (30.9%) had bacteremia and 94 (34.2%) had IAI within 30 days post LT. Enterococci and staphylococci were the most common causes and represented 32% each of bacteremias with 35% and 30% receptively in IAI. There were 153 isolates of Enterococcus species from 59 patients; 51.7% were susceptible to ampicillin, 83.1% to vancomycin and 100% to linezolid. Of all bactermias, 8% were due to VRE. Amongst gram negative isolates (n= 68 patients), 21 patients had organisms with Amp-C inducible beta-lactamases; 15 patients had Pseudomonas (84.6% susceptible to piperacillin tazobactam) and of 15 patients with E. coli isolates, only 76.5% were susceptible to piperacillin-tazobactam.

Conclusion: Rates of early post transplant bacteremia and IAI in our LT population are comparable to the literature. Enterococci and staphylococci were the most frequent pathogens and there was a high rate of ampicillin and vancomycin resistance in eterococcal isolates in this population. Rates of resistance in gram negatives isolated was also higher than expected based on clinical perception and in comparison to our general ICU population. Further study is needed to assess the impact of these early infections on outcome post LT in this population. Our data highlight the importance of local epidemiology to guide peri-operative prophylaxis in LT.

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