title: Pathogenesis of early operative site infections after orthotopic liver transplantation.
abstract: BACKGROUND
  We hypothesized that operative site infections after orthotopic liver transplantation arise from bacteria in bile or jejunum.
  
  
  METHODS
  To ascertain the validity of this hypothesis and to assess the effect of systemic antibiotic prophylaxis, we obtained intraoperative cultures of peritoneum, fascia, explant and donor liver bile, and jejunal lumen in 77 liver transplantations, and we monitored outcome.
  
  
  RESULTS
  Pathogens were recovered from peritoneum, fascia, or bile in 11 cases. By univariate analysis, a positive culture was significantly associated with choledochojejunostomy (P=0.0002), previous liver transplantation (P=0.0002), and previous hepatobiliary surgery (P=0.002). Operative site infections during the first 2 weeks after transplantation occurred only in cases with positive intraoperative cultures, and three of the four infections were caused by the same bacteria detected intraoperatively. Antibiotic susceptibility of intraoperative isolates was tested in nine cases; infection occurred in two of three cases in which the isolates were resistant to the systemic antibiotic prophylaxis and in none of six cases with susceptible isolates.
  
  
  CONCLUSIONS
  Our findings suggest that systemic antibiotic prophylaxis for more than 2 days may be beneficial in cases with bacterial contamination of the operative site but may not be necessary in other cases.
authors.affiliation: Department of Medicine, University of Chicago Hospital, Illinois 60637, USA.
authors.forename: P M
authors.initials: PM
authors.lastname: Arnow
authors.forename: K C
authors.initials: KC
authors.lastname: Zachary
authors.forename: J R
authors.initials: JR
authors.lastname: Thistlethwaite
authors.forename: K D
authors.initials: KD
authors.lastname: Thompson
authors.forename: J L
authors.initials: JL
authors.lastname: Bova
authors.forename: K A
authors.initials: KA
authors.lastname: Newell
mesh_terms: D000658:Amoxicillin / Q000008:administration & dosage / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D001646:Bile / Q000382:microbiology; D002439:Cefotaxime / Q000008:administration & dosage / Q000627:therapeutic use; D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007432:Intraoperative Period; D016031:Liver Transplantation; D010406:Penicillins / Q000008:administration & dosage / Q000627:therapeutic use; D010537:Peritoneum / Q000382:microbiology; D013530:Surgical Wound Infection / Q000209:etiology* / Q000517:prevention & control
chemical_list: D002511:Cephalosporins; D010406:Penicillins; D000658:Amoxicillin; D002439:Cefotaxime