Stool cultures obtained before liver transplantation are useful for choice of perioperative antibiotic prophylaxis

Transpl Int. 1997;10(6):432-8. doi: 10.1007/s001470050082.

Abstract

Bacterial infections, especially cholangitis, are still common complications after liver transplantation (LTx). During recent years, multiresistant enterococci have become a nosocomial problem in transplant units. The present prospective study on 26 patients, including 24 patients with chronic liver disease, demonstrated that enterococci were the predominant micro-organism involved in post-LTx bacterial infections. They were cultured in the feces and in other sites of 10 out of 13 (77%) patients who underwent extensive examinations. Ampicillin-resistant Enterococcus faecium strains were isolated in urine or feces of 2 of the 13 patients prior to LTx. Similarly, resistance to ampicillin and gentamicin, the empirically used antibiotics for patients with fever of unknown origin, was found in E. faecium strains in 3 and 2 patients, respectively. Moreover, multiresistant E. faecium and E. faecalis strains were demonstrated in 46% of the patients in the postoperative period (3 months). However, no vancomycin-resistant enterococci were isolated. The use of antibiotics within 4 months prior to LTx significantly increased the risk of developing ampicillin-resistant bacteria at the time of LTx and of infections with bacteria of enteric origin after LTx (P = 0.03 and 0.01, respectively). We conclude that stool and urine cultures performed prior to LTX may be useful for selecting prophylactic antibiotic regimens.

MeSH terms

  • Adult
  • Ampicillin / therapeutic use*
  • Ampicillin Resistance
  • Antibiotic Prophylaxis*
  • Bacterial Infections / blood
  • Bacterial Infections / prevention & control
  • Bacterial Infections / urine
  • Cholangitis / etiology
  • Cholangitis / microbiology
  • Disease Susceptibility / etiology
  • Disease Susceptibility / microbiology
  • Disease Susceptibility / therapy
  • Drug Resistance, Multiple
  • Enterobacteriaceae / drug effects
  • Enterobacteriaceae / isolation & purification
  • Feces / microbiology*
  • Female
  • Fever / drug therapy
  • Fever / etiology
  • Fever / microbiology
  • Gentamicins / therapeutic use*
  • Humans
  • Liver Transplantation / adverse effects*
  • Male
  • Postoperative Complications / drug therapy
  • Postoperative Complications / etiology
  • Postoperative Complications / microbiology
  • Prospective Studies
  • Risk Factors
  • Time Factors

Substances

  • Gentamicins
  • Ampicillin