title: Early intra-abdominal infections associated with orthotopic liver transplantation.
abstract: BACKGROUND
  Postoperative infections remain a significant problem among liver transplant recipients (LTRs). An early cause of morbidity after liver transplantation is intra-abdominal infection (IAI) about which there are limited data.
  
  
  METHODS
  We report a retrospective review of 169 adult LTRs from January 1, 2002 to June 9, 2006, comparing those who developed early postoperative IAI (peritonitis, biliary tract infection, abdominal abscess, or enteritis) with those who did not to identify clinical features and risk factors, analyze epidemiology, and assess graft and patient survival.
  
  
  RESULTS
  Sixty-eight patients (40%) had 104 infections, with 148 pathogens isolated. Leukocytosis (53%) and fever (34%) were the most common clinical features, and peritonitis (43%) was the most common manifestation. Enterococcus spp., the most frequent single pathogens, comprised 26% of organisms cultured. There were significant associations of IAI with pretransplant ascites (P=0.002), posttransplant dialysis (P=0.015), and non-IAI surgical complications (P<0.001). There was a trend toward graft failure in patients with IAI (P=0.051) but increased mortality was not associated with IAI. Use of pretransplant antibiotics was significantly associated with development of multiple drug-resistant organisms in IAI (P=0.032).
  
  
  CONCLUSIONS
  IAI occurred at a relatively high rate in the early postoperative period, and fever was not a major indicator. In patients receiving antibiotics within 2 weeks before transplantation, multiple drug-resistant organisms often caused IAI. In addition, the presence of pretransplant ascites, posttransplant dialysis, and wound infection or reoperation after transplant should alert one to the increased risk of IAI in LTRs.
authors.affiliation: Section of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA. gereid@comcast.net
authors.forename: Gail E
authors.initials: GE
authors.lastname: Reid
authors.forename: Shellee A
authors.initials: SA
authors.lastname: Grim
authors.forename: Howard
authors.initials: H
authors.lastname: Sankary
authors.forename: Enrico
authors.initials: E
authors.lastname: Benedetti
authors.forename: Jose
authors.initials: J
authors.lastname: Oberholzer
authors.forename: Nina M
authors.initials: NM
authors.lastname: Clark
mesh_terms: D000328:Adult; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D001424:Bacterial Infections / Q000145:classification / Q000453:epidemiology*; D002177:Candidiasis / Q000453:epidemiology; D003586:Cytomegalovirus Infections / Q000453:epidemiology; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology*; D006526:Hepatitis C / Q000601:surgery; D006519:Hepatitis, Alcoholic / Q000601:surgery; D006801:Humans; D007239:Infections / Q000453:epidemiology*; D007964:Leukocytosis / Q000453:epidemiology; D016031:Liver Transplantation / Q000009:adverse effects* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology*; D012189:Retrospective Studies