ABSTRACT
BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) is an emergent microorganism of infections after liver transplant (LT). The aim of this study was to analyze the risk factors for CRE acquisition and infection after LT. METHODS: This was a prospective cohort study involving patients who underwent LT in the 2010 to 2014 period. Surveillance cultures for CRE were collected immediately before LT and weekly thereafter until hospital discharge. RESULTS: We analyzed 386 patients undergoing a total of 407 LTs. Before LT, 68 (17.6%) patients tested positive for CRE, 11 (16.2%) of those patients having CRE infection, whereas 119 (30.8%) patients acquired CRE after LT. Post-LT CRE infection was identified in 59 (15.7%) patients: Klebsiella pneumoniae was isolated in 83.2%; surgical site infection was the most common type of infection (46.7%). Multivariate analysis showed that post-LT dialysis was the only risk factor for post-LT CRE acquisition. Eighty-two percent of patients who underwent 3 or more post-LT dialysis sessions and acquired CRE before LT evolved with post-LT CRE infection. Other risk factors for CRE infection were acquisition of CRE post-LT, Model for End-Stage Liver Disease score greater than 32, combined transplantation, and reoperation. Patients who acquired CRE before LT had a high risk of developing CRE infection (P < 0.001). CONCLUSIONS: Measures for minimizing that risk, including altering the antibiotic prophylaxis, should be investigated and implemented.
Subject(s)
Carbapenems/therapeutic use , Drug Resistance, Bacterial , Enterobacteriaceae Infections/drug therapy , Liver Transplantation , Transplant Recipients , Adolescent , Adult , Aged , Chi-Square Distribution , Enterobacteriaceae Infections/diagnosis , Enterobacteriaceae Infections/microbiology , Enterobacteriaceae Infections/mortality , Female , Humans , Liver Transplantation/adverse effects , Liver Transplantation/mortality , Logistic Models , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Proportional Hazards Models , Prospective Studies , Renal Dialysis/adverse effects , Risk Assessment , Risk Factors , Surgical Wound Infection/diagnosis , Surgical Wound Infection/drug therapy , Surgical Wound Infection/microbiology , Time Factors , Treatment Outcome , Young AdultABSTRACT
Development of immunity to hepatitis B virus in cirrhotic patients waiting for liver transplantation is highly desirable. Though a double-dose regimen is available, little is know about its effectiveness. We examined the efficacy of double-dose hepatitis B virus vaccination in cirrhotic patients waiting for liver transplantation. We studied 43 patients who were waiting for liver transplantation. They were vaccinated with three doses of 40 mg hepatitis B vaccine at 0, 1 and 6 months; the normal dose is 20 microg. Efficacy was measured based on seroconversion of anti-HBs. Global response to the primary vaccination scheme was 67.5% (29 patients). Forty-one per cent of responders had anti-HBs titers above 1,000 IU/mL. No factors were associated with response, based on multivariate analysis. The vaccination scheme of 40 microg at 0, 1 and 6 months was superior to conventional vaccination doses (20 microg) for cirrhotic patients on a waiting list for liver transplantation.
Subject(s)
Hepatitis B Surface Antigens/blood , Hepatitis B Vaccines/immunology , Hepatitis B/prevention & control , Liver Cirrhosis/immunology , Adult , Dose-Response Relationship, Immunologic , Enzyme-Linked Immunosorbent Assay , Female , Hepatitis B/immunology , Hepatitis B Vaccines/administration & dosage , Hepatitis B virus/immunology , Humans , Immunization Schedule , Liver Cirrhosis/surgery , Liver Transplantation , Male , Middle Aged , Retrospective Studies , Waiting Lists , Young AdultABSTRACT
Development of immunity to hepatitis B virus in cirrhotic patients waiting for liver transplantation is highly desirable. Though a double-dose regimen is available, little is know about its effectiveness. We examined the efficacy of double-dose hepatitis B virus vaccination in cirrhotic patients waiting for liver transplantation. We studied 43 patients who were waiting for liver transplantation. They were vaccinated with three doses of 40 mg hepatitis B vaccine at 0, 1 and 6 months; the normal dose is 20 mg. Efficacy was measured based on seroconversion of anti-HBs. Global response to the primary vaccination scheme was 67.5 percent (29 patients). Forty-one per cent of responders had anti-HBs titers above 1,000 IU/mL. No factors were associated with response, based on multivariate analysis. The vaccination scheme of 40 mg at 0, 1 and 6 months was superior to conventional vaccination doses (20 mg) for cirrhotic patients on a waiting list for liver transplantation.
