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. 2021 Feb 1;105(2):338-345.
doi: 10.1097/TP.0000000000003231.

Risk Factors and Impact of Perioperative Prophylaxis on the Risk of Extended-spectrum β-Lactamase-producing Enterobacteriaceae-related Infection Among Carriers Following Liver Transplantation

Elsa Logre  1 , Frédéric Bert  2 , Linda Khoy-Ear  1 , Sylvie Janny  1 , Mikhaël Giabicani  1 , Bénédicte Grigoresco  1 , Amélie Toussaint  1 , Fédérica Dondero  3 , Safi Dokmak  3 , Olivier Roux  4 , Claire Francoz  4   5 , Olivier Soubrane  3   5   6 , François Durand  4   5   6 , Catherine Paugam-Burtz  1   5   6 , Emmanuel Weiss  1   5   6
Affiliations

Risk Factors and Impact of Perioperative Prophylaxis on the Risk of Extended-spectrum β-Lactamase-producing Enterobacteriaceae-related Infection Among Carriers Following Liver Transplantation

Elsa Logre et al. Transplantation. .

Abstract

Background: Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) carriage is frequent among liver transplant (LT) recipients, thereby fostering a large empirical carbapenem prescription. However, ESBL-E infections occur in only 10%-25% of critically ill patients with rectal colonization. Our aim was to identify risk factors for post-LT ESBL-E infection in colonized patients. The effect of perioperative antimicrobial prophylaxis (AP) was also analyzed in patients with prophylaxis lasting <48 hours and without proven intraoperative infection.

Methods: Retrospective study from a prospective database including patients with a positive ESBL-E rectal screening transplanted between 2010 and 2016.

Results: Among the 749 patients transplanted, 100 (13.3%) were colonized with an ESBL-E strain. Thirty-nine (39%) patients developed an infection related to the same ESBL-E (10 pulmonary, 11 surgical site, 13 urinary, 5 bloodstream) within 11 postoperative days in median. Klebsiella pneumoniae carriage, model for end-stage liver disease ≥25, preoperative spontaneous bacterial peritonitis prophylaxis, and antimicrobial exposure during the previous month were independent predictors of ESBL-E infection. We propose a colonization to infection risk score built on these variables. The prevalence of infection for colonization to infection score of 0, 1, 2, and ≥3 were 7.4%, 26.3%, 61.9%, and 91.3%, respectively. Of note, the incidence of post-LT ESBL-E infection was lower in case of perioperative AP targeting colonizing ESBL-E (P = 0.04).

Conclusions: Thirty-nine percentage of ESBL-E carriers develop a related infection after LT. We identified predictors for ESBL-E infection in carriers that may help in rationalizing carbapenem prescription. Perioperative AP targeting colonizing ESBL-E may be associated with a reduced risk of post-LT ESBL-E infections.

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Conflict of interest statement

E.W. reports personal fees from Merck Sharp & Dohme France and Biomerieux and travel reimbursements from MSD France. The other authors declare no conflicts of interest.

Comment in

References

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    1. Freire MP, Villela Soares Oshiro IC, Bonazzi PR, et al. Surveillance culture for multidrug-resistant gram-negative bacteria: performance in liver transplant recipients. Am J Infect Control. 2017; 45:e40–e44
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    1. Bert F, Larroque B, Paugam-Burtz C, et al. Pretransplant fecal carriage of extended-spectrum β-lactamase–producing Enterobacteriaceae and infection after liver transplant, France Emerg Infect Dis 2012; 18:908–916

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