Multidrug-resistant bacterial infections after liver transplantation: prevalence, impact, and risk factors

Background and Aims

Multidrug-resistant (MDR) bacterial infections are an increasing healthcare problem worldwide. This study analyzes the incidence, burden, and risk factors associated with MDR infections after liver transplantation (LT).

Methods

This retrospective, multicenter cohort study included adult patients who underwent LT between January 2017 and January 2020. Risk factors related to pre-LT disease, surgical procedure, and postoperative stay were analyzed. Multivariate logistic regression analysis was performed to identify independent predictors of MDR bacterial infections within the first 90-days after LT.

Results

We included 1,045 LT (960 patients) performed at nine centers across Spain. The mean age was 56.8 ± 9.3 years, 75.4% (n=782) were male. Alcohol-related liver disease was the most prevalent underlying etiology (43.2.%, n=451). Bacterial infections occurred in 432 patients (41.3%), who presented with a total of 679 episodes of infection (respiratory infections, 19.3%; urinary tract infections, 18.5%; bacteremia, 13.2% and cholangitis 11%, among others). MDR bacteria were isolated in 227 LT (21.7%) (348 episodes). Enterococcus faecium (22.1%), E. coli (18.4%), and Pseudomonas aeruginosa (15.2%) were the most frequently isolated microorganisms. In multivariate analysis, previous intensive care unit admission (0-3 months before LT), previous MDR bacterial infections (0-3 months before LT), and an increasing number of packed red blood cell units transfused during surgery were identified as independent predictors of multi-resistant infections. Mortality at 30, 90, 180, and 365 days was significantly higher in patients with MDR isolates.

Conclusion

MDR infections are highly prevalent after LT and have a significant impact on prognosis. E. faecium is the most frequently isolated MDR microorganism. New pharmacological and surveillance strategies aimed at preventing MDR infections after LT should be considered for patients with high-risk factors.