title: Risk factors associated with preoperative fecal carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae in liver transplant recipients.
abstract: OBJECTIVE
  The aim of the study was to identify risk factors associated with pre-transplant fecal carriage of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae in liver transplant recipients.
  
  
  METHODS
  Over a 3-year period (January 2009-December 2011), 317 patients who underwent liver transplantation were screened preoperatively for fecal carriage of ESBL-producing Enterobacteriaceae. Risk factors for fecal carriage were investigated by univariate analysis and stepwise logistic regression.
  
  
  RESULTS
  Of the 317 patients screened, 50 (15.7%) harbored an ESBL-producing isolate. Previous infection with an ESBL-producing organism had developed during the last 6 months in 20% of fecal carriers versus in none of the non-carriers. Other variables associated with fecal carriage were a model for end-stage liver disease score ≥25, pre-transplant stay in the intensive care unit ≥48 h, hospital stay ≥10 days in the last 6 months, a history of spontaneous bacterial peritonitis (SBP), exposure to a β-lactam agent in the last month, and prophylaxis with norfloxacin. Independent predictors of fecal carriage in the multivariate logistic regression model were exposure to a β-lactam agent in the month preceding transplantation (odds ratio [OR] = 7.8, confidence interval [CI] = 4-15.5, P < 0.001), and a history of SBP (OR = 2.4, CI = 1.1-4.9, P = 0.02).
  
  
  CONCLUSIONS
  Previous infection with an ESBL-producing isolate, recent exposure to a β-lactam agent, and a history of SBP are risk factors for preoperative fecal carriage of ESBL-producing Enterobacteriaceae in liver transplant recipients. Patients at risk of fecal carriage should receive intraoperative prophylaxis and, when necessary, empiric postoperative antimicrobial treatment that includes coverage for these organisms.
authors: Service de Microbiologie, Hôpital Beaujon, AP-HP, Clichy, France.
authors: F
authors: F
authors: Bert
authors: B
authors: B
authors: Larroque
authors: F
authors: F
authors: Dondero
authors: F
authors: F
authors: Durand
authors: C
authors: C
authors: Paugam-Burtz
authors: J
authors: J
authors: Belghiti
authors: R
authors: R
authors: Moreau
authors: M-H
authors: MH
authors: Nicolas-Chanoine
mesh_terms: D000328:Adult; D000583:Amikacin; D002440:Cefoxitin; D002939:Ciprofloxacin; D024881:Drug Resistance, Bacterial; D058625:End Stage Liver Disease / Q000150:complications / Q000601:surgery*; D016972:Enterobacter cloacae / Q000302:isolation & purification / Q000502:physiology; D004755:Enterobacteriaceae / Q000302:isolation & purification* / Q000502:physiology; D004756:Enterobacteriaceae Infections / Q000150:complications / Q000382:microbiology*; D004926:Escherichia coli / Q000302:isolation & purification / Q000502:physiology; D004927:Escherichia coli Infections / Q000150:complications / Q000382:microbiology; D005243:Feces / Q000382:microbiology*; D005260:Female; D006801:Humans; D015378:Imipenem; D007709:Klebsiella / Q000302:isolation & purification / Q000502:physiology; D007710:Klebsiella Infections / Q000150:complications / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000302:isolation & purification / Q000502:physiology; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D010397:Penicillanic Acid / Q000031:analogs & derivatives; D010538:Peritonitis; D010878:Piperacillin; D000077725:Piperacillin, Tazobactam Drug Combination; D057234:Preoperative Period; D012307:Risk Factors; D012720:Severity of Illness Index; D001618:beta-Lactamases / Q000378:metabolism*; D047090:beta-Lactams
chemical_list: D047090:beta-Lactams; D000077725:Piperacillin, Tazobactam Drug Combination; D002939:Ciprofloxacin; D002440:Cefoxitin; D015378:Imipenem; D000583:Amikacin; D010397:Penicillanic Acid; D001618:beta-Lactamases; D010878:Piperacillin
keywords: ESBL; Enterobacteriaceae; extended-spectrum β-lactamase; fecal carriage; liver transplant; spontaneous bacterial peritonitis