title: Risk factors for Staphylococcus aureus infection in liver transplant recipients.
abstract: Staphylococcus aureus is the leading cause of bacterial infection in liver transplant recipients. Preoperative nasal carriage of methicillin-resistant S. aureus (MRSA) is associated with a high risk of infection. We conducted a retrospective cohort study in order to identify independent risk factors for early-onset S. aureus infection after liver transplantation. Patients were screened preoperatively for methicillin-susceptible S. aureus (MSSA) and MRSA nasal carriage. Risk factor analysis was performed by univariate analysis followed by stepwise logistic regression. Of the 323 patients included, 63 (19.5%) patients developed S. aureus infection (36 MRSA, 27 MSSA) within 1 month of surgery. Variables significantly associated with infection in the univariate analysis were MRSA and MSSA nasal carriage, alcoholic cirrhosis, absence of hepatocellular carcinoma, decreased prothrombin ratio, and presence of ascites. In the multivariate analysis, MRSA carriage (odds ratio [OR]: 20.9, P < 0.0001), MSSA carriage (OR: 3.4, P = 0.0004), alcoholic cirrhosis (OR: 2.4, P = 0.01) and decreased prothrombin ratio (OR: 1.2, P = 0.01) were independent predictors of infection. Molecular typing showed that the infecting isolate was identical to the isolate from the nose in most patients. In conclusion, preoperative nasal carriage of MRSA and MSSA is an independent risk factor for S. aureus infection in liver transplant recipients. The infection is most often of endogenous origin. Alcoholic cirrhosis and the severity of liver failure are also associated with a high risk of infection.
authors.affiliation: Services de Microbiologie, Hôpital Beaujon, Clichy, France. ic.bert@bjn.ap-hop-paris.fr
authors.forename: Frédéric
authors.initials: F
authors.lastname: Bert
authors.forename: Claire
authors.initials: C
authors.lastname: Bellier
authors.forename: Ludovic
authors.initials: L
authors.lastname: Lassel
authors.forename: Valérie
authors.initials: V
authors.lastname: Lefranc
authors.forename: François
authors.initials: F
authors.lastname: Durand
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
authors.forename: France
authors.initials: F
authors.lastname: Mentré
authors.forename: Bruno
authors.initials: B
authors.lastname: Fantin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002353:Carrier State / Q000175:diagnosis*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications / Q000601:surgery; D017093:Liver Failure / Q000150:complications / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D016106:Methicillin Resistance; D008875:Middle Aged; D015233:Models, Statistical; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000382:microbiology*; D013211:Staphylococcus aureus