Deep Surgical Site Infections (dSSI) After Liver Transplantation (LTx): Emergence of Multiple-Drug Resistant (MDR) Pathogens
1University of Pittsburgh Medical Center, Pittsburgh, PA
2University of Pittsburgh, Pittsburgh, PA
3VA Pittsburgh Health System, Pittsburgh, PA.
Meeting: 2015 American Transplant Congress
Abstract number: 172
Keywords: Bile duct, Intra-abdominal infection, Prophylaxis, Risk factors
Session Information
Session Name: Concurrent Session: ID - Epidemiology, Resistance, Geographic Infections
Session Type: Concurrent Session
Date: Monday, May 4, 2015
Session Time: 2:15pm-3:45pm
Presentation Time: 2:27pm-2:39pm
Location: Room 115-C
Purpose: We described the epidemiology, microbiology and outcomes of dSSI after LTx.
Methods: We performed a single center retrospective study of 332 consecutive patients undergoing LTX from January 2010 through June 2014.
Results: 74% of patients received ampicillin-sulbactam for prophylaxis; 9% received tigecycline due to pre-LTx VRE carriage. 17% (55) had dSSI within 90 days, 22% (12) of whom had >1 infection. Overall, peritonitis and intra-abdominal abscesses were the most common. The median time from LTx to dSSI was 14 days. Gram negative rods (GNR), Gram positive cocci, and Candida accounted for 49%, 36% and 15%, respectively. The most common bacteria were members of Enterobacteriaceae (EnteroB- 43%), of which Klebsiella pneumoniae was the most common. Enterococcus faecium was also common (26%), of which 93% were VRE. 58% of EnteroB were MDR and 18% were carbapenem-resistant (CR). 69% of all recovered organisms were resistant to the prophylactic antibiotics used. Post-operative (post-op) bile leak (p<.0001), ERCP procedure after LTx (p=.001), prolonged operative time (p=.002), and Hepatitis C infection (p=0.03) were independent risk factors for dSSI. Bile leak was a consistent risk factor for VRE, MDR EnteroB and CR EnteroB (p<.0001 for all). Post-op ERCP was additional risk factor for infection due to VRE (p<.0001) and MDR EnteroB (p=.02). Pre-operative VRE colonization was an independent risk factor for VRE infection (p<.0001). Choice of antibiotic prophylaxis was not associated with risk of dSSI. Patients with infections had a higher 90-day mortality (16% vs 5%, p=.004).
Discussion: This study is most concerning for the high rate of dSSI due to MDR GNR and VRE after LTx. Bile leak and post-LTx ERCP were independent risk factors for these pathogens. The data suggest surgical complications rather than specific prophylactic antibiotic regimens were the major determinants of MDR dSSI. The source of these MDR organisms was likely pre-existing gastrointestinal colonization. Further study of pre-LTx screening and targeted antimicrobial strategies is warranted.
To cite this abstract in AMA style:
Viehman J, Clarke L, Shields R, Clancy C, Nguyen M. Deep Surgical Site Infections (dSSI) After Liver Transplantation (LTx): Emergence of Multiple-Drug Resistant (MDR) Pathogens [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/deep-surgical-site-infections-dssi-after-liver-transplantation-ltx-emergence-of-multiple-drug-resistant-mdr-pathogens/. Accessed May 12, 2025.« Back to 2015 American Transplant Congress