Surgical site infection in living-donor liver transplant recipients: a prospective study.
BACKGROUND
Infection is a constant threat for the living-donor liver transplantation (LDLT) recipients, although little information is available on the occurrence of infection in such patients.


METHODS
One hundred and thirteen consecutive LDLT recipients were prospectively followed for the presence of surgical site infections (SSIs) defined by CDC from April 2001 to March 2002. Risk factors for SSIs were evaluated by univariate and multivariate analysis.


RESULTS
Of the 113 LDLT recipients, 42 (37%) developed 57 episodes of SSIs (21 intraabdominal abscess, 20 peritonitis, 8 cholangitis, and 9 wound). Of the 57 episodes, 29 (51%) had secondary bacteremia in 19 patients. Causative pathogens, including 17 episodes of polymicrobial infections, were 37 gram-positive cocci (17 Staphylococcus aureus, 16 Enterococcus spp., and 4 others), 40 gram-negative rods (25 Enterobacteriaceae, 13 Pseudomonas aeruginosa, and 4 others), and 2 Candida albicans. Univariate analysis revealed that ABO incompatibility and repeat surgery were associated with the development of SSIs. Also, univariate analysis revealed that adult recipients, ABO incompatibility, total operation duration, repeat surgery, and NNIS risk index were associated with secondary bacteremia. Multivariate analysis revealed that ABO incompatibility (OR: 14.0; 95% CI, 2.52-77.2) and repeat surgery (OR: 9.29; 95% CI, 2.00-43.1) were independently associated with secondary bacteremia. Eleven of the 42 cases (26%) who developed SSIs died. Of these 11 cases, 5 (45%) developed secondary bacteremia within 30 days before death.


CONCLUSIONS
SSIs occurred in 37% of LDLT recipients. ABO incompatibility and repeat surgery increased the risk of developing SSIs with secondary bacteremia, which correlated with poor prognosis.
Iinuma
Yoshitsugu
Y
Department of Clinical Laboratory Medicine, Kyoto University Hospital, 54 Kawahara-cho. Shogoin, Sakyo-ku, Kyoto 606-8507, Japan. yiinuma@kuhp.kyoto-u.c.jp
Senda
Kazuyoshi
K
Fujihara
Naoko
N
Saito
Takashi
T
Takakura
Shunji
S
Kudo
Toyoichiro
T
Kiuchi
Tetsuya
T
Tanaka
Koichi
K
Ichiyama
Satoshi
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002177:Candidiasis / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control; D013997:Time Factors
D000900:Anti-Bacterial Agents