Multidrug-resistant bacterial infections prevalent after liver transplant

Patients who underwent liver transplantation (LT) are vulnerable to multidrug-resistant bacteria (MDRB) infections, which can significantly affect their prognosis, suggests a study. The most common pathogen is Enterococcus faecium.

Nine hundred sixty adult patients (mean age 56.8 years, 75.4 percent male) who underwent a total of 1,045 LT procedures at nine centres across Spain between January 2017 and January 2020 were included in this retrospective, multicentre cohort study.

A group of researchers analysed the risk factors associated with pre-LT disease, surgical procedure, and postoperative stay. They also identified the independent predictors of MDRD infections within the first 90 days post-LT via multivariate logistic regression analysis.

The most prevalent underlying aetiology was alcohol-related liver disease (43.2 percent; n=451). Of the patients, 432 (41.3 percent) had bacterial infections, presenting a total of 679 episodes of infection (respiratory infections: 19.3 percent; urinary tract infections: 18.5 percent; bacteremia: 13.2 percent; cholangitis: 11 percent, among others).

MDRB were isolated in 227 patients (21.7 percent; 248 episodes). Enterococcus faecium (22.1 percent) was the most frequently isolated microorganism, followed by Escherichia coli (18.4 percent), and Pseudomonas aeruginosa (15.2 percent).

Multivariate analysis revealed the following predictors of MDRB infections: previous ICU admission (0‒3 months before LT), previous MDRD infections (0‒3 months before LT), and an increasing number of packed red blood cell units transfused during surgery.

Notably, patients with MDRB infections had higher mortality at 30, 90, 180, and 365 days.

“New pharmacological and surveillance strategies aimed at preventing MDRB infections after LT should be considered for patients with risk factors,” the researchers said.