Risk factors associated with preoperative fecal carriage of extended‐spectrum β‐lactamase‐producing Enterobacteriaceae in liver transplant recipients. Issue 1 (16th December 2013)

• Record Type: Journal Article
• Authors: Bert, F.; Larroque, B.; Dondero, F.; Durand, F.; Paugam‐Burtz, C.; Belghiti, J.; Moreau, R.; Nicolas‐Chanoine, M.‐H.
• Is Part Of: Transplant infectious disease. Volume 16:Issue 1(2014)
• Page Start: 84
• Page End: 89
• Publication Date: 2013-12-16
• Subjects: Transplantation of organs, tissues, etc -- Complications -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 617.01
• DOI: 10.1111/tid.12169
• Languages: English
• ISSNs: 1398-2273

Abstract

<abstract abstract-type="main" id="tid12169-abs-0001"> <title>Abstract</title> <sec id="tid12169-sec-0001" sec-type="section"> <title>Objective</title> <p>The aim of the study was to identify risk factors associated with pre‐transplant fecal carriage of extended‐spectrum β‐lactamase (ESBL)‐producing Enterobacteriaceae in liver transplant recipients.</p> </sec> <sec id="tid12169-sec-0002" sec-type="section"> <title>Patients and methods</title> <p>Over a 3‐year period (January 2009–December 2011), 317 patients who underwent liver transplantation were screened preoperatively for fecal carriage of ESBL‐producing Enterobacteriaceae. Risk factors for fecal carriage were investigated by univariate analysis and stepwise logistic regression.</p> </sec> <sec id="tid12169-sec-0003" sec-type="section"> <title>Results</title> <p>Of the 317 patients screened, 50 (15.7%) harbored an ESBL‐producing isolate. Previous infection with an ESBL‐producing organism had developed during the last 6 months in 20% of fecal carriers versus in none of the non‐carriers. Other variables associated with fecal carriage were a model for end‐stage liver disease score ≥25, pre‐transplant stay in the intensive care unit ≥48 h, hospital stay ≥10 days in the last 6 months, a history of spontaneous bacterial peritonitis (SBP), exposure to a β‐lactam agent in the last month, and prophylaxis with norfloxacin. Independent predictors of fecal carriage in the multivariate logistic regression model were exposure to a β‐lactam agent in the month preceding transplantation (odds ratio [OR] = 7.8, confidence interval [CI] = 4–15.5, <italic>P</italic> < 0.001), and a history of SBP (OR = 2.4, CI = 1.1–4.9, <italic>P</italic> = 0.02).</p> </sec> <sec id="tid12169-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Previous infection with an ESBL‐producing isolate, recent exposure to a β‐lactam agent, and a history of SBP are risk factors for preoperative fecal carriage of ESBL‐producing Enterobacteriaceae in liver transplant recipients. Patients at risk of fecal carriage should receive intraoperative prophylaxis and, when necessary, empiric postoperative antimicrobial treatment that includes coverage for these organisms.</p> </sec> </abstract>