title: Surgical site infections in liver transplant recipients in the model for end-stage liver disease era: an analysis of the epidemiology, risk factors, and outcomes.
abstract: In recipients of liver transplantation (LT), surgical site infection (SSIs) are among the most common types of infection occurring in the first 60 days after LT. In 2007, the Model for End-Stage Liver Disease (MELD) scoring system was adopted as the basis for prioritizing organ allocation. Patients with higher MELD scores are at higher risk for developing SSIs as well as other health care-associated infections. However, there have been no studies comparing the incidence of SSIs in the pre-MELD era with the incidence in the period since its adoption. Therefore, the objectives of this study were to evaluate the incidence, etiology, epidemiology, and outcomes of post-LT SSIs in those 2 periods and to identify risk factors for SSIs. We evaluated all patients who underwent LT over a 10-year period (2002-2011). SSI cases were identified through active surveillance. The primary outcome measure was an SSI during the first 60 days after LT. Risk factors were analyzed via logistic regression, and 60-day survival rates were evaluated via Cox regression. We evaluated 543 patients who underwent LT 597 times. The SSI rates in the 2002-2006 and 2007-2011 periods were 30% and 24%, respectively (P = 0.21). We identified the following risk factors for SSIs: retransplantation, the transfusion of more than 2 U of blood during LT, dialysis, cold ischemia for >400 minutes, and a cytomegalovirus infection. The overall 60-day survival rate was 79%. Risk factors for 60-day mortality were retransplantation, dialysis, and a longer surgical time. The use of the MELD score modified the incidence and epidemiology of SSIs only during the first year after its adoption. Risks for SSIs were related more to intraoperative conditions and intercurrences after LT than to a patient's status before LT.
authors.affiliation: Infection Control Team, Clinical Hospital, São Paulo, Brazil.
authors.forename: Maristela Pinheiro
authors.initials: MP
authors.lastname: Freire
authors.forename: Isabel C V
authors.initials: IC
authors.lastname: Soares Oshiro
authors.forename: Patricia Rodrigues
authors.initials: PR
authors.lastname: Bonazzi
authors.forename: Thais
authors.initials: T
authors.lastname: Guimarães
authors.forename: Estela Regina
authors.initials: ER
authors.lastname: Ramos Figueira
authors.forename: Telésforo
authors.initials: T
authors.lastname: Bacchella
authors.forename: Silvia Figueiredo
authors.initials: SF
authors.lastname: Costa
authors.forename: Luiz Augusto
authors.initials: LA
authors.lastname: Carneiro D'Albuquerque
authors.forename: Edson
authors.initials: E
authors.lastname: Abdala
mesh_terms: D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D001803:Blood Transfusion; D058625:End Stage Liver Disease / Q000628:therapy*; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012086:Reoperation / Q000009:adverse effects; D012307:Risk Factors; D012720:Severity of Illness Index; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome