Bacterial infections in the early period after liver transplantation: etiological agents and their susceptibility
Dariusz Kawecki, Andrzej Chmura, Marek Pacholczyk, Beata Lagiewska, Leszek Adadynski, Dariusz Wasiak, Jaroslaw Czerwinski, Piotr Malkowski, Anna Sawicka-Grzelak, Katarzyna Kot, Marta Wroblewska, Wojciech Rowinski, Magdalena Durlik, Leszek Paczek, Miroslaw Luczak
Med Sci Monit 2009; 15(12): CR628-637
The study comprises an analysis of bacterial infections in the early period after liver transplantation (LT) in adults.
Material and Method: Eighty-three patients were followed for four weeks after LT. Samples comprised mainly blood, urine, surgical-site specimens, sputum, and stool. Culture and identification of the isolated microorganisms was done in accordance with standard microbiological procedures. Susceptibility testing was carried out using CLSI guidelines. Statistical analysis was done with Medi-Stat.
Results: In total, 913 samples from LT recipients were cultured. Of the 469 isolated strains, 331 (70.6%) were Gram-positive bacteria, 133 (28.4%) were Gram-negative bacteria, and 5 (1.0%) were yeast-like fungal strains. Of the 284 surgical-site isolates, 222 (78%) were Gram-positive and 61 (21.5%) were Gram-negative bacteria. Of the 99 blood culture isolates, 75 (75.8%) were Gram-positive and 22 (22.2%) of Gram-negative bacterial strains. Of the 73 urine samples, 46 (63.0%) were strains of Gram-negative, 25 (34.0%) of Gram-positive bacteria, and 2 (3.0%) fungal strains. In the 13 respiratory tract samples were 9 (69.0%) Gram-positive and 4 (31.0%) Gram-negative strains. In the 54 stool samples, 63.0% and 16.7% were C. difficile toxin- and culture-positive, respectively. In total, 138 strains of MRCNS, 10 of MRSA, 80 of HLAR, and 19 ESBL(+) were detected.
Conclusions: The isolation of MDR bacterial strains such as MRSA (52.6%), MRCNS (81.7%), HLAR (86.0%), and ESBL(+) Gram-negative rods (12.5%) from patients after LT indicates the need for strict adherence to infection control procedures.
Keywords: Surgical Wound Infection - microbiology, Prospective Studies, Middle Aged, Poland, Postoperative Complications - microbiology, Male, Microbial Sensitivity Tests, Liver Transplantation - adverse effects, Humans, Infection Control, Gram-Positive Bacteria - isolation & purification, Gram-Negative Bacteria - isolation & purification, Fungi - isolation & purification, Female, Bacterial Infections - microbiology, Aged, Adult, Adolescent, Time Factors, young adult