title: Stool cultures obtained before liver transplantation are useful for choice of perioperative antibiotic prophylaxis.
abstract: Bacterial infections, especially cholangitis, are still common complications after liver transplantation (LTx). During recent years, multiresistant enterococci have become a nosocomial problem in transplant units. The present prospective study on 26 patients, including 24 patients with chronic liver disease, demonstrated that enterococci were the predominant micro-organism involved in post-LTx bacterial infections. They were cultured in the feces and in other sites of 10 out of 13 (77%) patients who underwent extensive examinations. Ampicillin-resistant Enterococcus faecium strains were isolated in urine or feces of 2 of the 13 patients prior to LTx. Similarly, resistance to ampicillin and gentamicin, the empirically used antibiotics for patients with fever of unknown origin, was found in E. faecium strains in 3 and 2 patients, respectively. Moreover, multiresistant E. faecium and E. faecalis strains were demonstrated in 46% of the patients in the postoperative period (3 months). However, no vancomycin-resistant enterococci were isolated. The use of antibiotics within 4 months prior to LTx significantly increased the risk of developing ampicillin-resistant bacteria at the time of LTx and of infections with bacteria of enteric origin after LTx (P = 0.03 and 0.01, respectively). We conclude that stool and urine cultures performed prior to LTX may be useful for selecting prophylactic antibiotic regimens.
authors.affiliation: Karolinska Institute, Huddinge University Hospital, Sweden.
authors.forename: L M
authors.initials: LM
authors.lastname: Barkholt
authors.forename: J
authors.initials: J
authors.lastname: Andersson
authors.forename: B G
authors.initials: BG
authors.lastname: Ericzon
authors.forename: A C
authors.initials: AC
authors.lastname: Palmgren
authors.forename: U
authors.initials: U
authors.lastname: Broomé
authors.forename: F
authors.initials: F
authors.lastname: Duraj
authors.forename: A
authors.initials: A
authors.lastname: Bergquist
authors.forename: G
authors.initials: G
authors.lastname: Herlenius
authors.forename: C E
authors.initials: CE
authors.lastname: Nord
mesh_terms: D000328:Adult; D000667:Ampicillin / Q000627:therapeutic use*; D000668:Ampicillin Resistance; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000097:blood / Q000517:prevention & control / Q000652:urine; D002761:Cholangitis / Q000209:etiology / Q000382:microbiology; D004198:Disease Susceptibility / Q000209:etiology / Q000382:microbiology / Q000628:therapy; D018432:Drug Resistance, Multiple; D004755:Enterobacteriaceae / Q000187:drug effects / Q000302:isolation & purification; D005243:Feces / Q000382:microbiology*; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D005839:Gentamicins / Q000627:therapeutic use*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D005839:Gentamicins; D000667:Ampicillin