Preventing Postoperative Infection In Liver Transplant Patients : Preoperative Assessment, Intraoperative Challenges And Postoperative Management

Abstract (1) Background: Infection after liver transplant recipients (LTR) added a great burden to the healthcare system, associated with high morbidity and mortality. Infection prevention and control of LTR were particularly complicated due to application of immunological inhibitor and the surge of multidrug-resistant (MDR) pathogens. (2) Methods: We retrospectively reviewed 131 patients with postoperative infections at our center from 2019 to 2021 and the impact of active screening for infection on epidemiology and outcomes. (3) Results: Postoperative infections occurred in51.1% of LTR , a total of 149 isolates were detected in these infections patients. Time to tracheal intubation,hot ischemia time and tacrolimus concentration after LT were independent risk factors for postoperative infections. More isolated Gram-negative bacteria (65%) than positive bacteria (28%), then fungus (7%), were found. The predominant Gram-negative bacteria were Non-fermentative bacteria (31%), followed by Klebsiella pneumonia (15%). The main Gram-positive bacteria were Coagulase-negative Staphylococcus (CoNS, 14%) and Enterococcus (6%). The main infections included pulmonary infections (38%), abdominal infections (28%) and bloodstream infections (19%). Stenotrophomonas maltophilia (24%) and Klebsiella pneumonia (21%) were the principal pathogens associated with pulmonaryinfections, while Klebsiella pneumoniae (18%) and CoNS (16%) were the main pathogens of abdominal infections. CoNS (27%) and fungi(23%)contribute to half of bloodstream infections. 49%(73/149) of the pathogens were detected as MDR, mainly including Carbapenem-resistant Acinetobacter Baumannii (CRAB) (77%,10/13), CR Klebsiella Pneumoniae (CRKP) (46%,12/26), CR Pseudomonas aeruginosa (CRPAE) (46%,6/13),Meticillin-resistant Staphylococcus aureus (MRSA) (80%,4/5) and MRCoNS (67%,16/24). (4) Conclusions: Our results demonstrated the risk factors and microorganisms' antibiotic resistance characteristics of LT infection, with detailed analysis from different sites of infection. We further provided the empirical regimens base on local antibiotics data to assist the clinician to early initiate appropriate antibiotic therapy and effective infection prevention strategies for common pathogens in different infection sites. More experience, improved surgical techniques, and meticulous donor evaluation will help to minimize infection rates in patients after LT.