*Purpose: Bacterial infections may occur at any time but mostly within the first month post-transplant. However, since recent advances in transplant there has not been a comprehensive analysis to determine if patterns of bacterial infections have changed. This study will evaluate bacterial infections post liver transplant (LT) during a 16-year period.

*Methods: Single-center retrospective analysis of LT recipients from 2000-2016 with follow up of 3-year post LT. Patients were divided into 2 group based on when they were transplanted; Era (E1) 2000-09 and Era 2 (E2) 2010-16. Patient were included if they were first-time LT recipients and had immunosuppressive regimen of Tac, MMF and steroids (tapered off by 3-months). Post-op antibiotic prophylaxis consisted of pipracillin/tazobactam x 24 hrs for E1 and cefepime + metronidazole x 24 hrs for E2. Infection was defined as positive culture pathogen at any site.

*Results: Total 1202 patients were evaluated and divided into E1 (n=719) or E2 (n=483). There was no difference in mean age [E1: 52.8±10.6; E2; 55.9±9.2; p=NS] or gender. E2 subjects had higher MELD score [E1: 20.2; E2; 21.6; p<0.007]. No difference in total incidence of bacterial infections at any site [E1: 384 (53.4%); E2: 274 (56.7%) p=NS]; Gram(+) infections [E1: 330 (46%); E2: 225 (47%) p=NS], Gram(-) infections [E1: 207 (28.8); E2: 139 (28.8) p=NS] or bacteremia [E1: 130 (18%); E2; 68 (14.1%) p<0.08]. Hospital length of stay (days) was higher in patients who developed infections vs. no infections [E1: 19.3 ±15 vs. 10.9±9 (p>0.05); E2: 18±13 vs. 10.3±5.8 (p>0.05)] but no difference between the Era’s. E2 subjects had longer onset (days) to develop Gram (+) [E1: 14±10.6; E2; 24±9.2; p<0.001]; and Gram(-) [E1: 28±9.6; E2; 65±15; p<0.001]; however, in both Era’s, Gram(+) had earlier onset than Gram(-) infections p<0.001. Resistant pathogen ESBL was higher in E2 [E1: 5(0.7%); E2; 12 (2.5%); p<0.02] but no difference in VRE [E1: 90 (12.5%); E2; 46 (9.5); p<0.001]. In both Era’s 1-yr patient survival was decreased in patients who developed infections vs. no infections [E1: 339/352 (96.3%) vs. 314/367 (85.6%); E2 215/226 (95%) vs. 221/257 (86%) (p<0.05)]; however, there was no difference in survival between the Era’s.

*Conclusions:

Our data shows that in past 16 years, the incidence of bacterial infections post LT have remained the same but onset for developing infections has almost doubled and may occur later than the historic prediction of first 30 days post LT. Recently transplanted patients are also at greater risk of developing more resistant strains of bacteria.

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