EVALUATING RISK FACTORS FOR MULTI DRUG RESISTANCE POST LIVING DONOR LIVER TRANSPLANTATION.

Abstract

Introduction Bacterial infection after liver transplantation is the most common early complication after the operation, reported to be more than 60%-80%. Immunocompromised recipients are target for infection by multidrug resistant bacterial strains because of frequent antimicrobial usage. Understanding risk factors for infection can be used to guide the selection of the diagnostic approach and initial therapy. Aim of the work The aim of the study is to point out resistant bacterial strain to broad spectrum antibiotics and to identify the primary risk factors for antimicrobial resistance among recipient after living donor liver transplantation (LDLT). Patients and methods 122 recipients from 2008 to 2012 were screened at Ain Shams Center for Organ Transplantation (ASCOT) for the presence of risk factors for antimicrobial resistance either preoperative, intra-operative or post-operative. Routine cultures were withdrawn on day one post-operatively in the ICU and once patient is transferred to the ward and in case of fever, elevated C- reactive protein, White blood count (WBC) or procalcitonin. Results 42 patients, 7 females with mean age of 53± 6.4 years. Multivariate regression test revealed that prolonged operative time (P=0.0.16), multiple radiological interventions (P=0.040) and multiple antibiotic changes post operatively (P=0.038) were the main risk factors. 257 bacterial cultures were statistically analyzed, 70.8% were gram negative poly microbial resistant bacterial strains and 29.2% were gram positive resistant strains to third generation cephalosporin, carbapenems and quinolones. The most common organisms were Pseudomonas auerogenosa (25.8%), Klebsiella spp. (19.5%), MRSA (18%), Acinetobacter spp. and E.Coli (9.8%). The most common sites were biliary and abdominal drains (49.3%). Conclusion Gram negative polymicrobial resistant biliary infection is the most common bacterial infection after LDLT. Careful usage of antibiotics, short operative time and reduced rate of radiological intervention are recommended for better outcome.