Epidemiological Data on Antibiotic-resistant Bacteria Isolated in Liver Transplant Recipients / 대한이식학회지

ABSTRACT

BACKGROUND: Post-transplant infections by antibiotic-resistant bacteria (ARB) are increasing in prevalence because of the wide use of broad-spectrum antibiotics. At our center, the perioperative prophylaxis for liver transplant recipients consistes of cefoperazone/sulbactam and ampicillin. When the recipient develops signs of infection, the initial antibiotics are empirically replaced with meropenem and vancomycin. We analyzed the epidemiology of ARB to assess the appropriateness of replacing empirical antibiotics during the first month after liver transplantation. METHODS: We reviewed 88 patients who had undergone living donor liver transplant between January 2006 and September 2007. RESULTS: Two hundred and seventy-six strains of bacteria were microbiologically documented in 75 liver transplant recipients. The most common bacteria was Staphylocococcus aureus (27%), followed by coagulase-negative staphylococci (CNS, 20%), Enterococcus species (18%) and Klebsiella species (7%). Our data on the resistance pattern showed that 87.8% and 71.4% of the S. aureus and CNS were resistant to methicillin, respectively; 88% of the Enterococcus species were resistant to ampicillin and 24% to vancomycin; and 62% of all enteric gram-negative bacilli (GNB) were resistant to 3rd generation cephalosporins. No strains of meropenem-resistant GNB were detected. Only one glucose non-fermentative GNB was resistant to all antibiotics except aminoglyco sides and colistin. CONCLUSIONS: Mainly methicillin-resistant gram- positive bacterial strains, including S. aureus and CNS, can colonize in early period after transplantation. According to the epidemiologic data on the high prevalence of antibiotic-resistant organisms, the empirical treatment regimen at our center is considered as appropriate. However, shifting down to less-broad-spectrum antibiotics after the pathogens are confirmed is essential to lowering the rate of ARB.