Open AccessRisk factors for Enterobacteriaceae bacteremia after liver transplantation
Author(s) -
Bellier Claire,
Bert Frédéric,
Durand François,
Retout Sylvie,
Belghiti Jacques,
Mentré France,
Fantin Bruno
Publication year - 2008
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/j.1432-2277.2008.00673.x
Subject(s) - medicine , bacteremia , liver transplantation , enterobacter cloacae , enterobacteriaceae , klebsiella pneumoniae , gastroenterology , amikacin , retrospective cohort study , transplantation , ciprofloxacin , surgery , microbiology and biotechnology , antibiotics , biology , escherichia coli , biochemistry , gene
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.