TY - JOUR
T1 - Methicillin-resistant Staphylococcus aureus carriers are vulnerable to bloodstream infection after living donor liver transplantation
AU - Takemura, Yusuke
AU - Hibi, Taizo
AU - Shinoda, Masahiro
AU - Obara, Hideaki
AU - Minagawa, Takuya
AU - Kitago, Minoru
AU - Yagi, Hiroshi
AU - Abe, Yuta
AU - Matsubara, Kentaro
AU - Oshima, Go
AU - Hori, Shutaro
AU - Hoshino, Ken
AU - Yamada, Yohei
AU - Itano, Osamu
AU - Takano, Yaoko
AU - Kuroda, Tatsuo
AU - Hasegawa, Naoki
AU - Kitagawa, Yuko
N1 - Funding Information:
The authors are grateful to the Surgical Site Infection Prevention and Control Team of Keio University Hospital for providing excellent technical assistance in perioperative care and for insightful suggestions in conducting the study.
Publisher Copyright:
© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
PY - 2019/12/1
Y1 - 2019/12/1
N2 - Background: Bloodstream infection (BSI) is a life-threatening complication after living donor liver transplantation (LDLT). We aimed to explore the incidence and predisposing factors of BSI at our institution. Methods: We conducted a retrospective cohort analysis on all consecutive adults with BSI within 6 months after LDLT performed between 2005 and 2016. For antimicrobial prophylaxis, ampicillin/sulbactam, cefotaxime, and micafungin were administered. From 2011, methicillin-resistant Staphylococcus aureus (MRSA) carriers were decolonized using mupirocin ointment and chlorhexidine gluconate soap. Risk factors for BSI were identified by uni- and multivariate logistic regression. Results: Of a total of 106 LDLTs, 42 recipients (40%) suffered BSI. The BSI group demonstrated significantly higher in-hospital mortality rates compared with the non-BSI group (24% vs. 7%, P =.01). We identified MRSA carrier (odds ratio [OR], 19.1; P <.001), ABO incompatibility (OR, 2.9; P =.03), and estimated glomerular filtration rate <30 mL/min/1.73m2 (OR, 15.8; P =.02) as independent risk factors for BSI. Decolonization treatment for MRSA carriers did not reduce the incidence of all-cause BSI but reduced the frequency of BSI caused by MRSA. Conclusion: To our knowledge, for the first time, MRSA carriers were revealed to be highly vulnerable to BSI after LDLT.
AB - Background: Bloodstream infection (BSI) is a life-threatening complication after living donor liver transplantation (LDLT). We aimed to explore the incidence and predisposing factors of BSI at our institution. Methods: We conducted a retrospective cohort analysis on all consecutive adults with BSI within 6 months after LDLT performed between 2005 and 2016. For antimicrobial prophylaxis, ampicillin/sulbactam, cefotaxime, and micafungin were administered. From 2011, methicillin-resistant Staphylococcus aureus (MRSA) carriers were decolonized using mupirocin ointment and chlorhexidine gluconate soap. Risk factors for BSI were identified by uni- and multivariate logistic regression. Results: Of a total of 106 LDLTs, 42 recipients (40%) suffered BSI. The BSI group demonstrated significantly higher in-hospital mortality rates compared with the non-BSI group (24% vs. 7%, P =.01). We identified MRSA carrier (odds ratio [OR], 19.1; P <.001), ABO incompatibility (OR, 2.9; P =.03), and estimated glomerular filtration rate <30 mL/min/1.73m2 (OR, 15.8; P =.02) as independent risk factors for BSI. Decolonization treatment for MRSA carriers did not reduce the incidence of all-cause BSI but reduced the frequency of BSI caused by MRSA. Conclusion: To our knowledge, for the first time, MRSA carriers were revealed to be highly vulnerable to BSI after LDLT.
KW - MRSA carrier
KW - bloodstream infection
KW - living donor liver transplantation
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U2 - 10.1111/ctr.13753
DO - 10.1111/ctr.13753
M3 - Article
C2 - 31692105
AN - SCOPUS:85075731502
SN - 0902-0063
VL - 33
JO - Clinical Transplantation
JF - Clinical Transplantation
IS - 12
M1 - e13753
ER -