title: The clinical impact of ganciclovir prophylaxis on the occurrence of bacteremia in orthotopic liver transplant recipients.
abstract: BACKGROUND
  Cytomegalovirus (CMV) infection or receipt of a CMV-seropositive donor liver has been shown to be an independent predictor of bacteremia in orthotopic liver transplant (OLT) recipients. However, prevention of CMV infection through use of intense CMV prophylaxis has not been examined to assess the impact on bacteremia in liver transplant recipients.
  
  
  METHODS
  We analyzed the impact of CMV prophylaxis on rates of bacteremia by examining 192 consecutive OLT recipients during a 2-year follow-up period.
  
  
  RESULTS
  There were 29 episodes of bacteremia. Univariate analysis of risk factors for bacteremia showed that invasive fungal disease, initial anti-lymphocyte immunosuppression, treatment for rejection, and use of solumedrol were significantly associated with increased risk. Receipt of >or=14 days of ganciclovir prophylaxis (hazard ratio [HR], 0.40; 95% CI [confidence interval], 0.18-0.87; P=.02), end-to-end biliary anastomosis, and receipt of <10 units of red blood cells (RBCs) were significantly associated with a decreased risk. Three-variable analysis controlling for end-to-end anastomosis and use of <10 units of RBCs, showed that use of >or=14 days of ganciclovir was still associated with a reduced risk of bacteremia (HR, 0.44; 95% CI, 0.20-0.98; P=.0437).
  
  
  CONCLUSIONS
  Among factors associated with bacteremia, use of prophylactic ganciclovir is independently associated with a significant reduction of bacteremia in OLT recipients.
authors.affiliation: Division of Geographic Medicine and Infectious Diseases, Tufts-New England Medical Center, Tufts University, Boston, Massachusetts 02111, USA.
authors.forename: L Silvia
authors.initials: LS
authors.lastname: Munoz-Price
authors.forename: Michelle
authors.initials: M
authors.lastname: Slifkin
authors.forename: Robin
authors.initials: R
authors.lastname: Ruthazer
authors.forename: Debra D
authors.initials: DD
authors.lastname: Poutsiaka
authors.forename: Susan
authors.initials: S
authors.lastname: Hadley
authors.forename: Richard
authors.initials: R
authors.lastname: Freeman
authors.forename: Richard
authors.initials: R
authors.lastname: Rohrer
authors.forename: Michael
authors.initials: M
authors.lastname: Angelis
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Cooper
authors.forename: Ralph
authors.initials: R
authors.lastname: Fairchild
authors.forename: Laurie
authors.initials: L
authors.lastname: Barefoot
authors.forename: Judy
authors.initials: J
authors.lastname: Bloom
authors.forename: Susan
authors.initials: S
authors.lastname: Fitzmaurice
authors.forename: David R
authors.initials: DR
authors.lastname: Snydman
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D016470:Bacteremia / Q000150:complications* / Q000517:prevention & control*; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000517:prevention & control*; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage* / Q000627:therapeutic use*; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000914:Antibodies, Viral; D000998:Antiviral Agents; D015774:Ganciclovir