title: Impact of positive preoperative surveillance blood cultures from chronic indwelling catheters in cadaveric intestinal transplant recipients.
abstract: Recurrent bloodstream infections are a common indication for intestinal transplantation (ITx). Often, clinical symptoms may be absent in the setting of bacteremia, especially in patients with chronic liver disease. This study investigated the incidence and impact of positive blood cultures (BCx) obtained from central venous catheters used for total parenteral nutrition (TPN) in asymptomatic patients immediately prior to cadaveric ITx. Of 13 consecutive patients transplanted between November 2003 and November 2004, 12 underwent preoperative surveillance BCx with four positives (33%). Isolates included Staphylococcus epidermidis (n = 2), methicillin-resistant Staphylococcus aureus, and Citrobacter freundii. All four patients with positive BCx displayed liver dysfunction at the time of transplant (> or = grade 2 fibrosis, total bilirubin >8.0 g/dL), three of whom were inpatients. In contrast, only three of eight nonbacteremic patients showed liver disease of comparable severity. Liver dysfunction and inpatient status at the time of transplant appear to predict positive blood cultures. Postoperative length of stay and time on the ventilator were significantly longer among bacteremic as compared with nonbacteremic patients, but there were no differences in intraoperative blood use, time to total parenteral nutrition independence, or operative time between bacteremic and nonbacteremic patients. Our study showed that occult bacteremia in asymptomatic pre-intestinal transplant patients was not uncommon and may increase postoperative morbidity. Preemptive removal of long-term central venous catheters should be considered prior to ITx.
authors.affiliation: Georgetown University Hospital Transplant Institute Center for Intestinal Rehabilitation and Transplantation, 3800 Reservoir Road NW, Washington, DC 20007, USA. csm5@gunet.georgetown.edu
authors.forename: C
authors.initials: C
authors.lastname: Matsumoto
authors.forename: S
authors.initials: S
authors.lastname: Kaufman
authors.forename: E
authors.initials: E
authors.lastname: Fennelly
authors.forename: J
authors.initials: J
authors.lastname: Davis
authors.forename: P
authors.initials: P
authors.lastname: Gupta
authors.forename: T M
authors.initials: TM
authors.lastname: Fishbein
mesh_terms: D002102:Cadaver; D002408:Catheters, Indwelling; D006801:Humans; D007422:Intestines / Q000637:transplantation*; D010289:Parenteral Nutrition, Total; D011300:Preoperative Care; D012189:Retrospective Studies; D014019:Tissue Donors; D014184:Transplantation, Homologous; D016896:Treatment Outcome