Bacterial infections in the early period after liver transplantation

Abstract

Multidrug resistant bacteria are increasingly isolated from transplant recipients and cause high morbidity, mortality. The aim of this study is to determine the disribution and etiologic agents of bacterial infections seen in the early period after liver transplantation. A retrospective study was conducted on 90 patients who underwent orthotopic liver transplantation consecutively from January 2008 to October 2010 at Baskent University Hospital. Microbiologically documented bacterial infections seen during the first month after liver transplantation were included in this study. A total of ninety liver transplantations were performed during the study period. Twenty eight bacterial infection episodes were diagnosed in 20 patients within 30 days after transplantation operation. Twelve (13%) of the infections were intraabdominal (9 Gram negative and 3 Gram positive), 8 (9%) were catheter-related (4 Gram negative, 4 Gram positive), 6 (6%) urinary tract infection (5 Gram negative, 1 Gram positive), 2 ventilator associated pneumonia (1 Gram negative, 1 Gram positive). A total of 19 episodes were caused by Gram negative bacteria and the remaining 9 were caused by Gram positive bacteria. Strains susceptible only to colistin and tigecycline were defined as extensively drug resistant (XDR). Seven of the isolated Gram negative strains were Klebsiella pneumoniae (2 ESBL positive, 2 XDR strains), 6 were Escherichia coli (4 ESBL positive strains), 4 Acinetobacter baumannii (3 XDR strains), 1 Pseudomonas aeruginosa. The distribution of the Gram positive pathogens were 4 Enterococcus faecium (2 were vancomycin resistant), 3 methicillin resistant coagulase negative staphylococci, 1 methicillin sensitive Staphylococcus aureus and 1 methicillin resistant Staphylococcus aureus. A total of 20 bacteremia episodes were detected of which 12 (60%) were secondary and 8 (40%) were primary. The incidence of colonization and infection with multi-drug resistant bacteria particularly Gram negative strains has been increasing throughout the world. Data regarding the transplantation patients are limited but common usage of extended spectrum antibiotics among these patients both during the preoperative and postoperative phases undoubtedly predispose to difficult-to treat infections. The infection rates seen in the early postoperative period obtained in this study are comparable with the previous ones but the high percentages of multidrug resistant strain is the alarming issue.