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

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.

Leflunomide for the treatment of trichodysplasia spinulosa in a liver transplant recipient.

Trichodysplasia spinulosa (TS) is a rare dermatologic complication associated with the immunosuppressive therapy used in solid organ transplantation. The distinctive clinical manifestation of this condition is spiny follicular papules on the face, ears, extremities, and trunk. Histopathologically, abnormally maturing hair follicles with hyperkeratotic material are noted. The condition is produced by the trichodysplasia spinulosa-associated polyomavirus. Treatment of this condition in the past has entailed a reduction in immunosuppression, topical agents such as cidofovir or retinoids, or oral valganciclovir. Herein, we report a case of generalized TS treated successfully with leflunomide.

Management of Bacillus bacteremia: the need for catheter removal.

Bacillus species are biofilm-forming organisms that are associated with Bacillus catheter-related bloodstream infections (CRBSIs). The optimal treatment of Bacillus CRBSIs is not known. Therefore, in the current study, we determined the role of long-term central venous catheter (CVC) removal and treatment with vancomycin compared with other agents in Bacillus CRBSIs by retrospectively reviewing the medical records of cancer patients with Bacillus bacteremia who had been treated at our institution from December 1990 to March 2008. True bacteremia was defined as a positive blood culture (>15 colony-forming units/mL) with signs and symptoms of infection (such as fever and chills). Bacillus CRBSI was defined in accordance with the Infectious Diseases Society of America guidelines as probable or definite. There were 94 Bacillus bacteremia episodes, 93 of which (99%) were Bacillus CRBSIs (28% definite and 71% probable). Neutropenia during bacteremia occurred in 29%. Almost all bacteremia patients (99%) had been treated with antibiotics; 63% had received vancomycin. Sepsis with hypotension occurred in 6%, and endocarditis in 1%. Bacillus isolates were susceptible to linezolid (100%), vancomycin (98%), tetracycline (77%), and rifampin (67%). All 4 recurrences occurred in patients in whom the CVC had not been removed (12%), whereas no recurrences occurred in patients whose CVC had been removed (p = 0.028). Patient outcome, in terms of fever and hospitalization duration after the infection, was similar in patients who had received < or =10 days of systemic antibiotics compared with patients who had received >10 days. In conclusion, catheter retention in patients with Bacillus CRBSIs is associated with a significantly higher recurrence rate. If the CVC is retained, treatment with non-vancomycin antibiotics is associated with significantly shorter hospitalization duration after the infection, which may be because glycopeptide antibiotics have poor activity against bacilli embedded in biofilm.

Management of the catheter in documented catheter-related coagulase-negative staphylococcal bacteremia: remove or retain?

BACKGROUND: Studies and guidelines recommending the retention of the central venous catheter (CVC) in patients with coagulase-negative staphylococcal bacteremia were based on loose definitions of bacteremia and/or did not evaluate the risk of recurrence. In this study, we used strict definitions of coagulase-negative staphylococcal bacteremia to determine the impact of CVC retention on response to and recurrence of infection. METHODS: During the period from July 2005 through December 2007, we retrospectively evaluated 188 patients with coagulase-negative staphylococcal bacteremia. Bacteremia was defined using the strict Centers for Disease Control and Prevention criteria of 2 positive blood culture results. Catheter-related bacteremia was confirmed by differential quantitative blood cultures (>or=3:1) or time to positivity (>2 h). RESULTS: Resolution of infection within 48 h after commencement of antimicrobial therapy was not influenced by CVC removal or exchange versus retention and occurred in 175 patients (93%). Multiple logistic regression analysis showed that infection was 7.0 times (95% confidence interval [CI], 1.5-32.6 times) more likely to fail to resolve in patients with an intensive care unit stay prior to infection ( P = .013 ) and 3.8 times (95% CI, 1.1-13.3 times) more likely to fail to resolve in patients who had other concurrent sites of infection (P = .041 ). Duration of therapy did not affect recurrence. Multiple logistic regression analysis revealed that patients with catheter retention were 6.6 times (95% CI, 1.8-23.9 times) more likely to have a recurrence than were those whose catheter was removed or exchanged (P = .004). CONCLUSIONS: CVC retention does not have an impact on the resolution of coagulase-negative staphylococcal bacteremia but is a significant risk factor of recurrence.