Bacteremia using the molecular adsorbent recirculating system in patients bridged to liver transplantation

To retrospectively analyze the incidence and implications of bacteremia in patients supported by a molecular adsorbent recirculating system bridged to liver transplantation.

From September 2000 to April 2003, 30 patients (17 males and 13 females, aged 15-70 years; median age, 52 years) presenting with acute-on-chronic liver failure were treated with a molecular adsorbent recirculating system.

Nine patients (30%) developed bacteremia (positive blood culture) during treatment, 100% of them died during the same hospital admission. The most common isolates were Pseudomonas aeruginosa (44.4%) and Escherichia coli (33.3%). Sputum (44.4%) and ascites (33.3%) represented the most common sources of infection followed by urine and purely bloodborne infections (11.1% each). The isolate in the sputum was Pseudomonas aeruginosa 100% of the time, whereas Escherichia coli was found in 66.6% of the ascites cultures. The hemodynamic profile of patients who developed positive blood cultures showed significantly lower systemic vascular resistance indexes compared with those of nonbacteremic patients before and after treatment. There was a statistically significant difference (P = 0.0002) in survival between the bacteremic (who all died) and the nonbacteriemic patients treated.

Bacteremia was found to be a negative prognostic factor for patients supported with a molecular adsorbent recirculating system and therefore, a contraindication to starting and/or continuing treatment. Infection should be carefully ruled out prior to initiating treatment using a molecular adsorbent recirculating system. Moreover, prophylaxis with broad-spectrum antibiotics that provide double coverage against Gram-negative bacteria should be mandatory.