title: Negative Pressure Wound Treatment of Infections Caused By Extensively Drug-Resistant Gram-Negative Bacteria After Liver Transplantation: Two Case Reports.
abstract: Although survival after liver transplantation (LT) has progressively improved over the last years, an increased prevalence of clinically relevant infections in LT patients is well documented. In particular, the spread of infections sustained by extensively drug-resistant bacteria (XDR) produced an increase in the incidence of wound infections. Implementation of treatments for these life-threatening events is mandatory. This study describes 2 LT patients in whom XDR wound infection was effectively treated using negative pressure wound treatment (NPWT) combined with targeted local and systemic antibiotic therapy. Over the last 3 years, 2 of 8 patients with XDR infection admitted to our unit developed wound infection caused by XDR Klebsiella pneumoniae (KP-XDR). Positive results of the abdominal fluid culture and of the wound swab for KP-XDR were followed by sepsis. In both cases wound debridement was required and deep fascial layer dehiscence was detected. Combination antibiotic therapy was administered for sepsis treatment and, after failure of conventional NPWT, a NPWT with local instillation (NPWTi; V.A.C.-Ulta/VeraFlo-Instillation Therapy-KCI USA, Inc., San Antonio, TX, USA) of colistin-rifampicin was applied. After NPWTi application a reduction in bacterial load and exudate was observed with reduction in inflammatory markers. A complete healing of wound was achieved and both patients are currently alive. Instillation and NPWT are widely discussed in the literature. Results of the present study indicate beneficial effects of NPWT combined with targeted local and systemic antibiotic therapy; in both cases a life-threatening complication was cured. We consider local instillation of selected antibiotics applied to NPWTi a valuable tool for deep wound infection sustained by XDR bacteria.
authors.affiliation: Hepatobiliarypancreatic Surgery Unit, IRCCS Ca'Granda - Ospedale Maggiore Policlinico Milano, Milan, Italy. Electronic address: dondossola.daniele@gmail.com.
authors.forename: D
authors.initials: D
authors.lastname: Dondossola
authors.affiliation: Hepatobiliarypancreatic Surgery Unit, IRCCS Ca'Granda - Ospedale Maggiore Policlinico Milano, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Cavenago
authors.affiliation: Infectious Disease Unit, Azienda Ospedaliera Luigi Sacco, Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Piconi
authors.affiliation: Hepatobiliarypancreatic Surgery Unit, IRCCS Ca'Granda - Ospedale Maggiore Policlinico Milano, Milan, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Antonelli
authors.affiliation: Hepatobiliarypancreatic Surgery Unit, IRCCS Ca'Granda - Ospedale Maggiore Policlinico Milano, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Melada
authors.affiliation: Hepatobiliarypancreatic Surgery Unit, IRCCS Ca'Granda - Ospedale Maggiore Policlinico Milano, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Lonati
authors.affiliation: Hepatobiliarypancreatic Surgery Unit, IRCCS Ca'Granda - Ospedale Maggiore Policlinico Milano, Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Gatti
authors.affiliation: Hepatobiliarypancreatic Surgery Unit, IRCCS Ca'Granda - Ospedale Maggiore Policlinico Milano, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Rossi
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D006801:Humans; D007711:Klebsiella pneumoniae; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D013530:Surgical Wound Infection / Q000382:microbiology / Q000628:therapy*; D014945:Wound Healing
chemical_list: D000900:Anti-Bacterial Agents