title: A comparative study of the use of selective digestive decontamination prophylaxis in living-donor liver transplant recipients.
abstract: BACKGROUND
  Bacterial infections are major causes of early morbidity and mortality after liver transplantation. Selective digestive decontamination (SDD) can be used pre-operatively for living-donor liver transplant (LD-LT), but its role in this setting remains controversial.
  
  
  METHODS
  To evaluate this strategy, we retrospectively analyzed a cohort of consecutive LD-LTs performed in our center from March 2007 to February 2011 and compared the incidence and nature of early infectious complications, length of intensive care unit stay and hospitalization, antibiotic use, and emergence of resistant bacteria in patients with or without SDD prophylaxis.
  
  
  RESULTS
  Of 148 LD-LTs in the study period, 111 received SDD prophylaxis while 37 did not. In a multivariate model, the independent factors associated with an increased risk of early post-transplant infections were length of postoperative mechanical ventilation (for every additional day odds ratio [OR] = 2.37, 95% confidence interval [CI] 1.4-4.0; P = 0.002), and choledochojejunostomy (OR = 4.5, 95% CI 1.95-10.5; P < 0.001). Use of SDD did not affect the rate or distribution of infectious complications, duration of hospitalization, antibiotic use, or acquisition of resistant bacteria (OR = 3.52, 95% CI 0.43-15.17; P = 0.376).
  
  
  CONCLUSIONS
  In conclusion, the use of SDD prophylaxis in LD-LT was not beneficial and should be avoided, as it offers no advantage and could potentiate the emergence of multidrug-resistant organisms.
authors.affiliation: Division of Infectious Diseases, University of Toronto, University Health Network, Toronto, Ontario, Canada; Multi-Organ Transplant Program, University of Toronto, University Health Network, Toronto, Ontario, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Katchman
authors.forename: M
authors.initials: M
authors.lastname: Marquez
authors.forename: F
authors.initials: F
authors.lastname: Bazerbachi
authors.forename: D
authors.initials: D
authors.lastname: Grant
authors.forename: M
authors.initials: M
authors.lastname: Cattral
authors.forename: C Y
authors.initials: CY
authors.lastname: Low
authors.forename: E
authors.initials: E
authors.lastname: Renner
authors.forename: A
authors.initials: A
authors.lastname: Humar
authors.forename: M
authors.initials: M
authors.lastname: Selzner
authors.forename: A
authors.initials: A
authors.lastname: Ghanekar
authors.forename: C
authors.initials: C
authors.lastname: Rotstein
authors.forename: S
authors.initials: S
authors.lastname: Husain
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology*; D001424:Bacterial Infections / Q000517:prevention & control*; D003091:Colistin / Q000008:administration & dosage / Q000627:therapeutic use; D003666:Decontamination / Q000379:methods*; D004064:Digestive System / Q000382:microbiology*; D004359:Drug Therapy, Combination; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D003091:Colistin
keywords: infection; liver transplant; living donor; selective digestive decontamination