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Surgical Site Infections After Liver Transplantation: Prospective Surveillance and Evaluation of 250 Transplant Recipients in Canada

Published online by Cambridge University Press:  11 July 2017

Yoichiro Natori ,
Rawan Kassar ,
Aled Iaboni ,
Seyed M. Hosseini-Moghaddam ,
James Vu ,
Shahid Husain ,
Eberhard L. Renner ,
David Grant  and
Coleman Rotstein
Yoichiro Natori
Affiliation:
Multi-Organ Transplant Program, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada Division of Infectious Diseases, Department of Medicine, University of Toronto, University Health Network, Toronto, Ontario, Canada
Rawan Kassar
Affiliation:
Multi-Organ Transplant Program, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada Division of Infectious Diseases, Department of Medicine, University of Toronto, University Health Network, Toronto, Ontario, Canada
Aled Iaboni
Affiliation:
Multi-Organ Transplant Program, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
Seyed M. Hosseini-Moghaddam
Affiliation:
Multi-Organ Transplant Program, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada Division of Infectious Diseases, Western University, London, Ontario, Canada
James Vu
Affiliation:
Multi-Organ Transplant Program, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada Division of Infectious Diseases, Department of Medicine, University of Toronto, University Health Network, Toronto, Ontario, Canada
Shahid Husain
Affiliation:
Multi-Organ Transplant Program, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada Division of Infectious Diseases, Department of Medicine, University of Toronto, University Health Network, Toronto, Ontario, Canada
Eberhard L. Renner
Affiliation:
Multi-Organ Transplant Program, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada Departments of Medicine University of Toronto, Toronto, Ontario, Canada
David Grant
Affiliation:
Multi-Organ Transplant Program, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada Department of Surgery, University of Toronto, Toronto, Ontario, Canada
Coleman Rotstein*
Affiliation:
Multi-Organ Transplant Program, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada Division of Infectious Diseases, Department of Medicine, University of Toronto, University Health Network, Toronto, Ontario, Canada
*
Address correspondence to Coleman Rotstein, MD, University Health Network, Toronto General Hospital, 200 Elizabeth Street, PMB 11-139, Toronto, Ontario M5G 2C4 ([email protected]).
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Abstract

OBJECTIVE

To evaluate the incidence of surgical-site infections (SSIs) in a cohort of liver transplant recipients and to assess risk factors predisposing patients to these infections.

DESIGN

Prospective observational cohort study.

SETTING

Single transplant center in Canada.

PATIENTS

Patients who underwent liver transplantation between February 2011 and August 2014.

METHODS

Multivariate logistic regression was used to identify independent risk factors for SSIs in liver transplant patients.

RESULTS

We enrolled 250 liver transplant recipients. The recipients’ median age at the time of transplantation was 56 years (range, 19–70 years), and 166 patients (66.4%) were male. Moreover, 47 SSIs were documented in 43 patients (17.2%). Organ-space, superficial, and deep SSIs were noted in 29, 7, and 3 patients, respectively. In addition, 2 patients developed superficial and organ-space SSIs, and another 2 patients were found to have deep as well as organ-space infections. In total, we identified 33 organ-space SSIs (70.2%), 9 superficial SSIs (19.1%), and 5 deep SSIs (10.6%). Factors predictive of SSIs by multivariate analysis were duct-to-duct anastomosis (odds ratio [OR], 3.88; 95% CI, 1.85–8.13; P<.001) and dialysis (OR, 3.57; 95% CI, 1.02–12.50; P=.046). Of the 66 organisms isolated in both deep and organ-space SSIs, 55 (83%) were resistant to cefazolin.

CONCLUSIONS

Organ-space SSIs are a common complication after liver transplantation. Duct-to-duct anastomosis and dialysis were independent risk factors associated with SSIs. Appropriate perioperative prophylaxis targeting patients with duct-to-duct anastomosis and dialysis while simultaneously providing optimum coverage for the potential pathogens causing SSIs is warranted.

Infect Control Hosp Epidemiol 2017;38:1084–1090

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 9 , September 2017 , pp. 1084 - 1090
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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