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Surgical Site Infections After Liver Transplantation: Prospective Surveillance and Evaluation of 250 Transplant Recipients in Canada

  • Yoichiro Natori (a1) (a2), Rawan Kassar (a1) (a2), Aled Iaboni (a1), Seyed M. Hosseini-Moghaddam (a1) (a3), James Vu (a1) (a2), Shahid Husain (a1) (a2), Eberhard L. Renner (a1) (a4), David Grant (a1) (a5) and Coleman Rotstein (a1) (a2)...
Abstract
OBJECTIVE

To evaluate the incidence of surgical-site infections (SSIs) in a cohort of liver transplant recipients and to assess risk factors predisposing patients to these infections.

DESIGN

Prospective observational cohort study.

SETTING

Single transplant center in Canada.

PATIENTS

Patients who underwent liver transplantation between February 2011 and August 2014.

METHODS

Multivariate logistic regression was used to identify independent risk factors for SSIs in liver transplant patients.

RESULTS

We enrolled 250 liver transplant recipients. The recipients’ median age at the time of transplantation was 56 years (range, 19–70 years), and 166 patients (66.4%) were male. Moreover, 47 SSIs were documented in 43 patients (17.2%). Organ-space, superficial, and deep SSIs were noted in 29, 7, and 3 patients, respectively. In addition, 2 patients developed superficial and organ-space SSIs, and another 2 patients were found to have deep as well as organ-space infections. In total, we identified 33 organ-space SSIs (70.2%), 9 superficial SSIs (19.1%), and 5 deep SSIs (10.6%). Factors predictive of SSIs by multivariate analysis were duct-to-duct anastomosis (odds ratio [OR], 3.88; 95% CI, 1.85–8.13; P<.001) and dialysis (OR, 3.57; 95% CI, 1.02–12.50; P=.046). Of the 66 organisms isolated in both deep and organ-space SSIs, 55 (83%) were resistant to cefazolin.

CONCLUSIONS

Organ-space SSIs are a common complication after liver transplantation. Duct-to-duct anastomosis and dialysis were independent risk factors associated with SSIs. Appropriate perioperative prophylaxis targeting patients with duct-to-duct anastomosis and dialysis while simultaneously providing optimum coverage for the potential pathogens causing SSIs is warranted.

Infect Control Hosp Epidemiol 2017;38:1084–1090

Copyright
Corresponding author
Address correspondence to Coleman Rotstein, MD, University Health Network, Toronto General Hospital, 200 Elizabeth Street, PMB 11-139, Toronto, Ontario M5G 2C4 (Coleman.Rotstein@uhn.ca).
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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