Impact of a Multimodal Approach in Prevention of Surgical Site Infection in Hepatic Transplant Recipients.
BACKGROUND
In liver transplant (LT) recipients, surgical site infection (SSI) represents an important cause of morbidity and mortality.


OBJECTIVE
This study measures the impact of a multimodal approach to the incidence of surgical site infection in LT recipients.


METHODS
All of the LT recipients in our department were registered on the national database in solid organ transplant. A study was performed in two analytical-interventional phases. Phase 1 took place between July 14, 2009, and February 20, 2014. Phase 2 took place between February 21, 2014, and July 15, 2015. The multimodal change implemented during phase 1 was that 0.5% alcoholic chlorhexidine and ether were applied to the surgical field; surgical prophylaxis was primarily with ampicillin/sulbactam plus cefazolin. In phase 2, 2% alcoholic chlorhexidine alone was applied to the surgical field. The prior standard prophylaxis was changed to piperacillin tazobactam administered during surgery as a continuous infusion of 13.5 g over 8 hours with a pre-incision loading dose of 4.5 g. The loading dose of piperacillin tazobactam was combined with a single dose of gentamicin of 5 mg/kg.


RESULTS
One hundred eight patients have received transplants since the start of the program: 82 patients during phase one and 26 patients during phase two. During phase 1, 13 cases of SSI were recorded, representing a rate of 15.85 per 100 transplants. Sixteen micro-organisms were isolated during phase 1, of which 12 corresponded to gram-negative bacilli. With regard to resistance profiles, 13 showed multidrug resistant and extensively drug resistant profiles. During phase 2, no cases of SSI were recorded (relative risk = 0.158 [95% confidence interval 0.0873-0.255], P = .0352].


CONCLUSIONS
A multimodal approach allowed for the reduction of the incidence of SSI in LTs and offered a protective strategy.
Unidad Bi Institucional de Enfermedades Hepáticas Complejas (Hospital Militar, Hospital de Clínicas), Programa de Trasplante Hepático, Montevideo, Uruguay; Cátedra de Enfermedades Infecciosas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay. Electronic address: jimeprieto78@gmail.com.
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Prieto
Unidad Bi Institucional de Enfermedades Hepáticas Complejas (Hospital Militar, Hospital de Clínicas), Programa de Trasplante Hepático, Montevideo, Uruguay; Cátedra de Enfermedades Infecciosas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
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Medina
Unidad Bi Institucional de Enfermedades Hepáticas Complejas (Hospital Militar, Hospital de Clínicas), Programa de Trasplante Hepático, Montevideo, Uruguay; Cátedra de Enfermedades Infecciosas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
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López
Unidad Bi Institucional de Enfermedades Hepáticas Complejas (Hospital Militar, Hospital de Clínicas), Programa de Trasplante Hepático, Montevideo, Uruguay.
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Rando
Cátedra de Enfermedades Infecciosas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
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Iglesias
Unidad Bi Institucional de Enfermedades Hepáticas Complejas (Hospital Militar, Hospital de Clínicas), Programa de Trasplante Hepático, Montevideo, Uruguay.
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Harguindeguy
Unidad Bi Institucional de Enfermedades Hepáticas Complejas (Hospital Militar, Hospital de Clínicas), Programa de Trasplante Hepático, Montevideo, Uruguay.
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Leites
Unidad Bi Institucional de Enfermedades Hepáticas Complejas (Hospital Militar, Hospital de Clínicas), Programa de Trasplante Hepático, Montevideo, Uruguay.
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Etlin
Unidad Bi Institucional de Enfermedades Hepáticas Complejas (Hospital Militar, Hospital de Clínicas), Programa de Trasplante Hepático, Montevideo, Uruguay.
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Menéndez
Unidad Bi Institucional de Enfermedades Hepáticas Complejas (Hospital Militar, Hospital de Clínicas), Programa de Trasplante Hepático, Montevideo, Uruguay; Cátedra de Enfermedades Infecciosas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
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Valverde
Unidad Bi Institucional de Enfermedades Hepáticas Complejas (Hospital Militar, Hospital de Clínicas), Programa de Trasplante Hepático, Montevideo, Uruguay.
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Scalone
Unidad Bi Institucional de Enfermedades Hepáticas Complejas (Hospital Militar, Hospital de Clínicas), Programa de Trasplante Hepático, Montevideo, Uruguay.
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Castelli
Unidad Bi Institucional de Enfermedades Hepáticas Complejas (Hospital Militar, Hospital de Clínicas), Programa de Trasplante Hepático, Montevideo, Uruguay.
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Grecco
Unidad Bi Institucional de Enfermedades Hepáticas Complejas (Hospital Militar, Hospital de Clínicas), Programa de Trasplante Hepático, Montevideo, Uruguay.
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Abelleira
Unidad Bi Institucional de Enfermedades Hepáticas Complejas (Hospital Militar, Hospital de Clínicas), Programa de Trasplante Hepático, Montevideo, Uruguay.
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González
Unidad Bi Institucional de Enfermedades Hepáticas Complejas (Hospital Militar, Hospital de Clínicas), Programa de Trasplante Hepático, Montevideo, Uruguay.
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Gerona
D000279:Administration, Cutaneous; D000328:Adult; D000667:Ampicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis / Q000379:methods; D002437:Cefazolin / Q000008:administration & dosage; D002710:Chlorhexidine / Q000008:administration & dosage; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004986:Ether / Q000008:administration & dosage; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage; D016905:Gram-Negative Bacterial Infections / Q000517:prevention & control*; D016908:Gram-Positive Bacterial Infections / Q000517:prevention & control*; D006801:Humans; D007262:Infusions, Intravenous; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D010878:Piperacillin / Q000008:administration & dosage; D000077725:Piperacillin, Tazobactam Drug Combination; D013407:Sulbactam / Q000008:administration & dosage; D013530:Surgical Wound Infection / Q000517:prevention & control*; D066027:Transplant Recipients
D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D005839:Gentamicins; D004986:Ether; D000077725:Piperacillin, Tazobactam Drug Combination; C035444:sultamicillin; D000667:Ampicillin; D010397:Penicillanic Acid; D002437:Cefazolin; D002710:Chlorhexidine; D013407:Sulbactam; D010878:Piperacillin