title: Strategies to reduce infectious complication using epidemiologic data analysis in liver transplant recipients.
abstract: BACKGROUND
  Infectious complications are major factors for morbidity and mortality in liver transplant recipients. To establish a proper strategy to reduce infectious complications, we analyzed epidemiologic and risk factors for post-transplant infections.
  
  
  METHODS
  We analyzed the medical records of 231 consecutive liver transplant recipients from December 2007 to November 2011, including at least 1-year follow up, for comparison with those from 1996 to 2005.
  
  
  RESULTS
  Among 231 patients, 126 (54.5%) experienced 244 infectious episodes, a rate of 1.05 per patient. Among overall mortality of 9.9% (23/231), infections were more prevalent (P = .04). Predominant infections were postoperative intra-abdominal problems (36.1%), peritonitis (15.2%), pneumonia (13.5%), bacteremia (4.1%), wound complications (1.6%), viral etiologies (18.0%), and other causes (11.5%). Causative organisms were bacterial (68.9%), viral (14.7%), fungal (7.0%), and unproven ones (9.4%). Multivariate analysis of risks for infection showed significant impacts of Model for End-stage Liver Disease score [P = .027; odds ratio (OR), 1.04], post-transplant biliary complications (P < .001; OR, 3.50), and rejection episodes (P = .023; OR, 3.39). Mortality was related to retransplantation (P = .003), post-transplant dialysis (P = .006), and infection (P = .056) upon univariate analysis, none of which were significant in multivariate analysis. Compared with data from the previous period, overall and infection-related mortality decreased from 24.5% to 9.9% and 52.9% to 26.1%, respectively. There were no significant changes in the types of infection or rate of drug-resistant bacteria, but candidal infections and cytomegalovirus reactivations were more prevalent.
  
  
  CONCLUSIONS
  Our data showed current perioperative antimicrobial regimens need not be changed: however, new strategies are needed to reduce infectious complications after liver transplantation, to reduce biliary complications and to properly manage rejection episodes.
authors.affiliation: Division of Infectious Disease, Department of Internal Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea. Electronic address: drksi@catholic.ac.kr.
authors.forename: S I
authors.initials: SI
authors.lastname: Kim
authors.forename: Y J
authors.initials: YJ
authors.lastname: Kim
authors.forename: J Y
authors.initials: JY
authors.lastname: Choi
authors.forename: S K
authors.initials: SK
authors.lastname: Yoon
authors.forename: H J
authors.initials: HJ
authors.lastname: Choi
authors.forename: G H
authors.initials: GH
authors.lastname: Na
authors.forename: Y K
authors.initials: YK
authors.lastname: You
authors.forename: D G
authors.initials: DG
authors.lastname: Kim
authors.forename: M W
authors.initials: MW
authors.lastname: Kang
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007239:Infections / Q000150:complications* / Q000382:microbiology / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis