The Effectiveness of Healthcare-Associated Infections Prevention Measures in the Incidence of Infections and In-Hospital Mortality After Liver Transplantation: A Quasi-Experimental Single-Center Study
1Hospital Israelita Albert Einstein, São Paulo, Brazil, 2Universidade Federal de São Paulo, São Paulo, Brazil, 3Universidade Federal de São Paulo, Sao Paulo, Brazil
Meeting: 2022 American Transplant Congress
Abstract number: 1635
Keywords: Infection, Liver transplantation
Topic: Clinical Science » Infection Disease » 24 - All Infections (Excluding Kidney & Viral Hepatitis)
Session Information
Session Name: All Infections (Excluding Kidney & Viral Hepatitis) IV
Session Type: Poster Abstract
Date: Tuesday, June 7, 2022
Session Time: 7:00pm-8:00pm
Presentation Time: 7:00pm-8:00pm
Location: Hynes Halls C & D
*Purpose: To evaluate the effectiveness of multifaceted control interventions (bundles) aimed at preventing multiple healthcare-associated infections (HAI) in liver transplant recipients.
*Methods: This quasi-experimental study enrolled 1,479 patients who underwent liver transplantation from 2002 to 2014. The cohort was split into two groups, from the time-point when the bundles started: before (2002 to 2007; n=519) and after (2007 to 2014; n=960). The primary outcome was HAI case incidence. Secondarily, HAI incidence density (1.000 patient or device-days) or incidence rate (%) was evaluated regarding each infection site: bloodstream infection, central line-associated (CLABSI) or not (BSI); urinary tract infections catheter-associated (CAUTI) or not (UTI); pneumonia, ventilator-associated (VAP), or not (PNM); and surgical site infection (SSI). Last, the exploratory outcome was in-hospital mortality. Multivariable analyses for HAI and in-hospital mortality were performed by logistic regression.
*Results: After the bundles were started off, the HAI incidence reduced from 38.3% to 17.2% (P<0.001), and the HAI incidence density reduced from 21.7 from 10.6 (P<0.001). Incidence density of CLABSI (2.76 vs. 1.30, P=0.04), VAP (12.3 vs. 1.85, P<0.001), BSI (1.81 vs. 0.51, P<0.001) and PNM (2.85 vs. 1.54, P=0.009), and the SSI rate (15.4 vs. 8.43, P<0.001) also reduced significantly. On the other hand, there was no significant reduction in CAUTI or UTI. In the multivariable analysis, the risk of HAI was increased if patients were undergoing hemodialysis (OR=1.96; P<0.001) and if they were receiving parenteral nutrition (OR=2.79; P<0.001). The MELD was significantly associated with the risk of HAI (MELD20 reference): OR=1.58 (P=0.007) for MELD20-29 and OR=2.94 (P<0.001) for MELD>29. Last, in-hospital mortality was 9.3%, being lower after the bundles had been started off (7.9% vs. 11.8%, P=0.010), which reduced the HAI risk by 73% (OR=0.27; P<0.001). In the multivariable analysis, the risk of in-hospital death was strongly associated with HAI: OR=2,41; P<0,001.
*Conclusions: Multifaceted infection control interventions significantly reduced HAI rates in patients submitted to liver transplantation. Consequently, the risk for in-hospital mortality, reaching high effectiveness even in a population at increased risk of infections.
To cite this abstract in AMA style:
Bittante C, Requião-Moura LR, Menezes F, Morgado S, Correa L, Camargo L. The Effectiveness of Healthcare-Associated Infections Prevention Measures in the Incidence of Infections and In-Hospital Mortality After Liver Transplantation: A Quasi-Experimental Single-Center Study [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/the-effectiveness-of-healthcare-associated-infections-prevention-measures-in-the-incidence-of-infections-and-in-hospital-mortality-after-liver-transplantation-a-quasi-experimental-single-center-study/. Accessed November 23, 2024.« Back to 2022 American Transplant Congress