The Effectiveness and Safety of the Short-Course Therapy in Liver Transplant Recipients With Uncomplicated Gram-Negative Bacteremia: A Retrospective Study

Abstract

Introduction: The appropriate duration of therapy for uncomplicated gram-negative bloodstream infection (GN-BSI) in liver transplant (LTx) recipients remains unknown. This study aims to explore the effectiveness of a short-course antimicrobial therapy.

Methods: This retrospective study was performed in a single LTx center in Japan. All LTx recipients with GN-BSI receiving 6-16 days of therapy with adequate source control between 2010 and 2022 were included. We collected data on demographics, underlying medical conditions, clinical manifestations, laboratory and microbiology data, ID consultation, oral switch therapy, and subsequent clinical course through chart review. We compared the 30-day composite outcome comprising mortality and recurrence of BSI or local infection between patients receiving a short-course (6-10 days) therapy and those receiving a long-course (11-16 days) therapy.

Results: Of 91 study participants, 27 (29.7%) and 64 (70.3%) received short-course and long-course antimicrobial therapy, respectively. Cholangitis was the most common source of BSI (57/91 [62.6%]). Overall, the primary composite outcome occurred in 18 patients (19.8%), most of which was the recurrence of local infection (n = 14). The primary composite outcome was numerically compatible between these groups (5/27 [18.5%] vs. 13/64 [20.3%]; p = 0.84).

Conclusions: A short-course therapy may be an effective option in selected LTx recipients with uncomplicated GN-BSI. Whether a short-course oral switch therapy is a viable option or not warrants further research.

Keywords: antimicrobial stewardship; bacteremia; liver transplantation.