Risk Factors for Invasive Surgical Site Infections Among Adult Single Liver Transplant Recipients at Duke University Hospital in the Period 2015-2020.

Abstract

Background

Invasive primary surgical site infections (IP-SSI) are a severe complication of liver transplant surgery. Identification of risk factors for IP-SSI is critical to IP-SSI prevention.

Methods

All adult single liver transplants performed at Duke University Hospital in the period 2015-2020 were reviewed for IP-SSI occurring within 90 d of transplant. Risks for IP-SSI were identified using least absolute shrinkage and selection operator variable selection procedure. A 2-sided P value of <0.05 was considered statistically significant.

Results

IP-SSI were identified in 34/470 (7.2%) adult single liver transplants. Repeat transplantation, spilt liver, Roux-en-Y biliary anastomosis, anastomotic leak, and post-transplant renal replacement therapy were positively associated with IP-SSI. IP-SSI were associated with increased length of index transplant hospitalization (24.5 versus 10.0 d, P < 0.01) and 1-y all-cause mortality (14.7% versus 4.1%, P = 0.02). Gram positive bacteria were the main pathogens (51.7%), followed by Gram negative bacteria (24.1%) and Candida (24.1%). Multidrug resistance bacteria increased over time (27.3% in 2015 versus 66.7% in 2020, P = 0.17).

Conclusions

In the setting of routine antimicrobial prophylaxis and an overall low rate of IP-SSI, surgical factors were the main determinants of IP-SSI among adult liver transplant recipients. IP-SSI had a negative impact on the length of index transplant hospitalization and 1-y mortality. While the surgical factors associated with an increased risk of IP-SSI are not easily modifiable, their impact may be best contained by close clinical monitoring and tailored antimicrobial therapy.

Department

Description

Provenance

Subjects

Citation

Published Version (Please cite this version)

10.1097/txd.0000000000001719

Publication Info

Carugati, Manuela, Sana Arif, Michael E Yarrington, Lindsay Y King, Matt Harris, Kyla Evans, Andrew S Barbas, Debra L Sudan, et al. (2024). Risk Factors for Invasive Surgical Site Infections Among Adult Single Liver Transplant Recipients at Duke University Hospital in the Period 2015-2020. Transplantation direct, 10(12). p. e1719. 10.1097/txd.0000000000001719 Retrieved from https://hdl.handle.net/10161/32363.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Carugati

Manuela Carugati

Associate Professor of Medicine
Arif

Sana Arif

Assistant Professor of Medicine
Yarrington

Michael Yarrington

Assistant Professor of Medicine
Barbas

Andrew Serghios Barbas

Associate Professor of Surgery
Sudan

Debra L Sudan

Professor of Surgery

I am interested clinically in all abdominal organ transplants (kidney, liver, pancreas and intestine).  I am specifically interested in intestine transplantation and improving intestine graft preservation and long-term graft function and patient survival.  In addition, I am interested in monitoring of patients to improve our ability to determine the etiology of graft dysfunction when there are complex interacting issues such as infection and rejection as well as examining better immunosuppressive regimens to maintain excellent graft function.  We have numerous research studies and trial to improve our knowledge in these areas and thereby contribute to improved patient outcomes!

Miller

Rachel Ann Miller

Professor of Medicine
Alexander

Barbara Dudley Alexander

Professor of Medicine

Clinical research related to infectious complications of solid organ and bone marrow transplantation, with a particular interest in the treatment and rapid diagnosis of fungal disease. Training the next generation of Transplant Infectious Disease Physicians is a special focus of mine as the Principal Investigator of our Interdisciplinary T32 Training Program funded the NIH. 


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