title: Selective decontamination of the digestive tract helps prevent bacterial infections in the early postoperative period after liver transplant.
abstract: In liver transplant (LTx) recipients, gut-associated bacterial and fungal organisms produce significant postoperative morbidity and mortality. We sought to assess the role of selective digestive decontamination (SDD) in preventing postoperative infections in a large single-center cohort of liver recipients transplanted under two non-simultaneous protocols. In 212 consecutive patients transplanted between 1/1/91 and 7/31/92, SDD (gentamicin 80 mg, polymyxin B 100 mg, nystatin suspension 10 mL) was employed, starting after induction of anesthesia and continued until POD 21 (SDD Group). In 157 consecutive patients transplanted between 1/1/93 and 12/31/93, SDD was not used (non-SDD Group). Both groups received IV vancomycin and cefotaxime prophylaxis. All culture-positive infections within the first 30 days post-LTx were recorded and classified as bacterial or fungal. Infection-related mortality (patients who died of infectious complications without any technical complication) was recorded. Groups did not differ in patient demographics, United Network for Organ Sharing (UNOS) status, use of veno-venous bypass, total/warm ischemia, or length of ICU stay. Infections developed in fewer SDD patients (56/212; 26%) than non-SDD patients (69/157; 44%) (p<0.001). The incidence of gram-negative infection was less in the SDD group (11% vs. 26%, p<0. 001) as was gram-positive infection (16% vs. 26%, p<0.001). Among patients who developed infection, there was no difference between groups in infections per patient. Primary graft non-function (PNF) developed in 20 SDD patients (7/20 had infections) and 8 non-SDD patients (6/8 had infections) (p=0.06). There were no differences in incidence of fungal infections or of infection-related mortality between groups. In the SDD group, there were fewer abdominal (p<0. 001), lung (p<0.001), wound (p<0.01), and urinary tract infections (p<0.05).
  
  
  CONCLUSIONS
  Use of SDD in liver recipients early after transplant was associated with significantly fewer infections in the early postoperative period.
authors.affiliation: Mount Sinai School of Medicine, Box 1104, One East 100th Street, New York, NY 10029, USA.
authors.forename: S
authors.initials: S
authors.lastname: Emre
authors.forename: A
authors.initials: A
authors.lastname: Sebastian
authors.forename: L
authors.initials: L
authors.lastname: Chodoff
authors.forename: P
authors.initials: P
authors.lastname: Boccagni
authors.forename: B
authors.initials: B
authors.lastname: Meyers
authors.forename: P A
authors.initials: PA
authors.lastname: Sheiner
authors.forename: E
authors.initials: E
authors.lastname: Mor
authors.forename: S R
authors.initials: SR
authors.lastname: Guy
authors.forename: E
authors.initials: E
authors.lastname: Atillasoy
authors.forename: M E
authors.initials: ME
authors.lastname: Schwartz
authors.forename: C M
authors.initials: CM
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D003666:Decontamination; D004064:Digestive System / Q000382:microbiology*; D006801:Humans; D007223:Infant; D016031:Liver Transplantation; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*