Risk factors for Enterobacteriaceae bacteremia after liver transplantation

$48.00 plus tax (Refund Policy)

Download / Buy Article:

Abstract:

Summary

Enterobacteriaceae are now the predominant pathogens isolated in bloodstream infections complicating orthotopic liver transplantation (OLT). We conducted a retrospective cohort study of patients who underwent OLT in a University hospital between 01/01/1997 and 31/03/2003 to investigate the risk factors of Enterobacteriaceae bacteremia (EB) after OLT. EB was defined as the isolation of an Enterobacteriaceae species from at least one blood culture within 3 months following OLT. Pre-, per- and postoperative variables were collected from the medical records and analyzed in relation to EB. Forty (12.5%) of the 320 patients developed EB. The origin of EB was abdominal in 32% of the patients, urinary in 18%, pulmonary in 10%, and primary in the remaining 40% of the patients. Two-thirds of EB occurred within 1 month following OLT. The main pathogens were Escherichia coli (42%), Enterobacter cloacae (17%) and Klebsiella pneumoniae (17%). Susceptibility rates varied from 82.5% for ciprofloxacin to 95% for amikacin. Fourteen patients (35%) with EB died. Variables significantly associated with EB after multivariate analysis were a MELD score >20 (OR: 2.79 [1.24–6.30], P = 0.013), transplantation for posthepatitic B (OR: 4.47 [1.67–11.98], P = 0.03) or posthepatitic C (OR: 3.79 [1.59–9.01], P = 0.03) cirrhosis, a positive bile culture (OR: 3.47 [1.19–10.13], P = 0.023) and return to surgery (including retransplantation) (OR: 2.72 [1.32–5.58], P = 0.006). EB is a frequent and severe complication following OLT. Patients grafted for a posthepatitic cirrhosis, with a severe pretransplantation status, with a positive bile culture and those undergoing reoperation have a high risk of developing EB.

Keywords: Enterobacteriaceae; bacteremia; liver transplantation

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1432-2277.2008.00673.x

Affiliations: 1:  Department of Internal Medicine, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy; and University Paris 7, Medical School, Paris, France 2:  Department of Microbiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France 3:  Department of Hepatology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy; and University Paris 7, Medical School, Paris, France 4:  Department of Biostatistics, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France 5:  Department of Digestive Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy; and University Paris 7, Medical School, Paris, France

Publication date: August 1, 2008

Related content

Tools

Favourites

Share Content

Access Key

Free Content
Free content
New Content
New content
Open Access Content
Open access content
Subscribed Content
Subscribed content
Free Trial Content
Free trial content
Cookie Policy
X
Cookie Policy
ingentaconnect website makes use of cookies so as to keep track of data that you have filled in. I am Happy with this Find out more