title: Selective intestinal decontamination with fluoroquinolones for the prevention of early bacterial infections after liver transplantation.
abstract: The role of selective intestinal decontamination with fluoroquinolones (FQ-SID) in the prevention of early bacterial infections (EBIs) in liver transplant recipients (LTRs) is unknown. We used the online database of the Spanish Network of Infection in Transplantation/Spanish Network for Research in Infectious Diseases, which prospectively analyzed 1010 LTRs from 12 Spanish hospitals from September 2003 to February 2005. We compared the incidence and etiology of EBIs (30 days after transplantation) in 415 LTRs from 4 centers that used FQ-SID (>7 days) and in 595 LTRs from 8 hospitals that did not use FQ-SID. A multivariate logistic regression analysis (including an adjustment for the transplant center factor) was performed to evaluate the potential protective factor of FQ-SID in the development of EBIs. We reported 266 EBI episodes in 252 LTRs (incidence = 24.9%). There were no differences in the incidence of EBIs between patients in the FQ-SID group and patients not in the FQ-SID group [109/415 (26.3%) versus 143/595 (24%), P = 0.9]. Although LTRs who received FQ-SID had a lower incidence of infections due to enteric bacteria (2.7% versus 6.5%, P = 0.007) and a higher incidence of infections due to nonfermenting gram-negative bacilli (6.6% versus 2.6%, P = 0.004), these findings could not be confirmed after an adjustment by the center factor in the multivariate models. We found no significant differences in the incidence of enterococcal infections (3.4% with FQ-SID versus 3.9% without FQ-SID, P = 0.5). Multivariate analysis did not confirm any protective effect of FQ-SID against the development of EBIs by enteric bacteria. In conclusion, FQ-SID does not reduce the incidence of EBIs in LTRs and could be withheld from this group of patients.
authors.affiliation: Unit of Infectious Diseases and Digestive Surgery and Abdominal Organ Transplantation, 12 de Octubre University Hospital, Madrid, Spain. rafasjg@yahoo.es
authors.forename: Rafael
authors.initials: R
authors.lastname: San-Juan
authors.forename: Jose M
authors.initials: JM
authors.lastname: Aguado
authors.forename: Carlos
authors.initials: C
authors.lastname: Lumbreras
authors.forename: Jesus
authors.initials: J
authors.lastname: Fortun
authors.forename: Oscar
authors.initials: O
authors.lastname: Len
authors.forename: Patricia
authors.initials: P
authors.lastname: Munoz
authors.forename: Miguel
authors.initials: M
authors.lastname: Montejo
authors.forename: Asunción
authors.initials: A
authors.lastname: Moreno
authors.forename: Elisa
authors.initials: E
authors.lastname: Cordero
authors.forename: Marino
authors.initials: M
authors.lastname: Blanes
authors.forename: Antonio
authors.initials: A
authors.lastname: Ramos
authors.forename: Julian
authors.initials: J
authors.lastname: Torre-Cisneros
authors.forename: Francisco
authors.initials: F
authors.lastname: López-Medrano
authors.forename: Jordi
authors.initials: J
authors.lastname: Carratala
authors.forename: Enrique
authors.initials: E
authors.lastname: Moreno
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications* / Q000628:therapy*; D002939:Ciprofloxacin / Q000627:therapeutic use; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology*; D006412:Hematopoietic Stem Cells / Q000166:cytology; D006801:Humans; D007422:Intestines / Q000382:microbiology*; D017093:Liver Failure / Q000150:complications / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009643:Norfloxacin / Q000627:therapeutic use; D016377:Organ Transplantation / Q000379:methods*; D011446:Prospective Studies; D012042:Registries; D013030:Spain; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D002939:Ciprofloxacin; D009643:Norfloxacin