Impact of a Short Duration, Narrow Spectrum Perioperative Antibiotic Prophylaxis Regimen on Multi-Drug Resistant Surgical Site Infections in Adult Orthotopic Liver Transplantation
1Pharmacy, UF Health Shands Hospital, Gainesville, FL, 2Infectious Diseases, UF Health Shands Hospital, Gainesville, FL, 3Transplant Surgery, University Health System, San Antonio, TX, 4Surgery, UF Health Shands Hospital, Gainesville, FL, 5Pharmacy, University Health System, San Antonio, TX
Meeting: 2019 American Transplant Congress
Abstract number: A357
Keywords: Infection, Liver transplantation, Prophylaxis, Surgical complications
Session Information
Session Name: Poster Session A: Transplant Infectious Diseases
Session Type: Poster Session
Date: Saturday, June 1, 2019
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall C & D
*Purpose: There is a paucity of data defining the optimal agent and timing of peri-operative antimicrobial prophylaxis in orthotopic liver transplantation (OLT). The purpose of this study was to evaluate the effects of a short duration, narrower spectrum peri-operative antibiotic prophylaxis regimen on multi-drug resistant (MDR) surgical site infection (SSI) rates.
*Methods: This was a single-center, retrospective cohort study comparing 24-hours of ampicillin-sulbactam (post-cohort) to 5-7 days of vancomycin with either cefepime and metronidazole or piperacillin-tazobactam (pre-cohort). The primary outcome was incidence of MDR SSIs. Patients were excluded if there were MDR organism(s) present pre-operatively. Secondary outcomes included rates of surgical site, nosocomial, and fungal infections, as well as hospital and intensive care unit (ICU) length of stay (LOS), antibiotic-free days, and in-hospital, all-cause mortality.
*Results: Baseline characteristics were balanced with the exception of Model for End-Stage Liver Disease (MELD-Na) score (31 vs 20, p = 0.005). There was no difference in MDR SSI between groups. Furthermore, there was no difference in any post-operative infection rates including overall rates of SSI (Table 1) or in-hospital mortality. When evaluated by MELD-Na score, there was still no statistically significant difference between groups. There were significantly more antibiotic-free days in the post-cohort (13.4 vs 18.3 days, p = 0.003). Additionally, there was a significantly shorter ICU and hospital LOS in the post-cohort (20.2 vs 9.3 days, p = 0.009 and 29.7 vs 15.3 days, p = 0.005).
*Conclusions: A peri-operative antibiotic prophylaxis regimen in OLTs consisting of 24-hours of ampicillin-sulbactam compared to a 5-7 day broader antibiotic regimen was not associated with any difference in rates of post-operative infections. It was however, associated with significantly more antibiotic-free days. Also, although this regimen was associated with a significantly shorter ICU and hospital LOS, this was likely confounded by the differences in disease severity between the groups.
To cite this abstract in AMA style:
John M, Maguigan K, Schain D, Thomas E, Efron P, Nelson J. Impact of a Short Duration, Narrow Spectrum Perioperative Antibiotic Prophylaxis Regimen on Multi-Drug Resistant Surgical Site Infections in Adult Orthotopic Liver Transplantation [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/impact-of-a-short-duration-narrow-spectrum-perioperative-antibiotic-prophylaxis-regimen-on-multi-drug-resistant-surgical-site-infections-in-adult-orthotopic-liver-transplantation/. Accessed September 7, 2024.« Back to 2019 American Transplant Congress