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Bundled strategies against infection after liver transplantation: Lessons from multidrug‐resistant P seudomonas aeruginosa
Author(s) -
Sato Asahi,
Kaido Toshimi,
Iida Taku,
Yagi Shintaro,
Hata Koichiro,
Okajima Hideaki,
Takakura Shunji,
Ichiyama Satoshi,
Uemoto Shinji
Publication year - 2016
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.24407
Subject(s) - medicine , bacteremia , procalcitonin , liver transplantation , infection control , pseudomonas aeruginosa , incidence (geometry) , antimicrobial , antibiotics , carbapenem , transplantation , surgery , sepsis , bacteria , microbiology and biotechnology , genetics , optics , physics , biology
Infection is a life‐threatening complication after liver transplantation (LT). A recent outbreak of multidrug‐resistant Pseudomonas aeruginosa triggered changes in our infection control measures. This study investigated the usefulness of our bundled interventions against postoperative infection after LT. This before‐and‐after analysis enrolled 130 patients who underwent living donor or deceased donor LT between January 2011 and October 2014. We initiated 3 measures after January 2013: (1) we required LT candidates to be able to walk independently; (2) we increased the hand hygiene compliance rate and contact precautions; and (3) we introduced procalcitonin (PCT) measurement for a more precise determination of empirical antimicrobial treatment. We compared factors affecting the emergence of drug‐resistant microorganisms, such as the duration of antimicrobial and carbapenem therapy and hospital stay, and outcomes such as bacteremia and death from infection between before (n = 77) and after (n = 53) the LT suspension period. The utility of PCT measurement was also evaluated. Patients' backgrounds were not significantly different before and after the protocol revision. Incidence of bacteremia (44% versus 25%; P = 0.02), detection rate of multiple bacteria (18% versus 4%; P = 0.01), and deaths from infections (12% versus 2%; P = 0.04) significantly decreased after the protocol revision. Duration of antibiotic (42.3 versus 25.1 days; P = 0.002) and carbapenem administration (15.1 versus 5.2 days; P < 0.001) and the length of postoperative hospital stay (85.4 versus 63.5 days; P = 0.048) also decreased after the protocol revision. PCT mean values were significantly higher in the bacteremia group (10.10 ng/mL), compared with the uneventful group (0.65 ng/mL; P = 0.002) and rejection group (2.30 ng/mL; P = 0.02). One‐year overall survival after LT significantly increased in the latter period (71% versus 94%; P = 0.001). In conclusion, the bundled interventions were useful in preventing infections and lengthening overall survival after LT.