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Published on: December 8, 2014
Selective intestinal decontamination for the prevention of early bacterial infections after liver transplantation
Elena Resino1, Rafael San-Juan1, Jose Maria Aguado1
1Elena Resino, Rafael San-Juan, Jose Maria Aguado, Unit of Infectious Diseases, 12 de Octubre University Hospital, Madrid 28041, Spain.
Abstract:
Bacterial infection in the first month after liver transplantation is a frequent complication that poses a serious risk for liver transplant recipients as contributes substantially to increased length of hospitalization and hospital costs being a leading cause of death in this period. Most of these infections are caused by gram-negative bacilli, although gram-positive infections, especially Enterococcus sp. constitute an emerging infectious problem. This high rate of early postoperative infections after liver transplant has generated interest in exploring various prophylactic approaches to surmount this problem. One of these approaches is selective intestinal decontamination (SID). SID is a prophylactic strategy that consists of the administration of antimicrobials with limited anaerobicidal activity in order to reduce the burden of aerobic gram-negative bacteria and/or yeast in the intestinal tract and so prevent infections caused by these organisms. The majority of studies carried out to date have found SID to be effective in the reduction of gram-negative infection, but the effect on overall infection is limited due to a higher number of infection episodes by pathogenic enterococci and coagulase-negative staphylococci. However, difficulties in general extrapolation of the favorable results obtained in specific studies together with the potential risk of selection of multirresistant microorganisms has conditioned controversy about the routinely application of these strategies in liver transplant recipients.
Insights
Selective intestinal decontamination (SID) reduces early gram-negative infections after liver transplants but may increase other bacterial infections. Its routine use remains controversial due to risks of multi-resistant organisms.
Area of Science:
- Transplantation
- Infectious Diseases
- Microbiology
Background:
- Bacterial infections are a major complication in the first month after liver transplantation, increasing mortality, hospitalization, and costs.
- Gram-negative bacilli are common pathogens, but gram-positive infections, particularly Enterococcus sp., are an emerging concern.
- High rates of early infections prompt investigation into prophylactic strategies like selective intestinal decontamination (SID).
Purpose of the Study:
- To evaluate the effectiveness of selective intestinal decontamination (SID) in preventing early bacterial infections post-liver transplantation.
- To assess the impact of SID on the overall spectrum of infections, including gram-negative and gram-positive pathogens.
- To address the controversy surrounding the routine application of SID in liver transplant recipients.
Main Methods:
- Selective intestinal decontamination (SID) involves administering antimicrobials with limited anaerobic activity.
- The goal of SID is to reduce the intestinal burden of aerobic gram-negative bacteria and/or yeast.
- Studies reviewed analyzed the impact of SID on infection rates and types in liver transplant patients.
Main Results:
- SID has demonstrated efficacy in reducing gram-negative bacterial infections post-liver transplantation.
- However, SID's effect on overall infection rates is limited due to an increase in infections caused by pathogenic enterococci and coagulase-negative staphylococci.
- Concerns exist regarding the extrapolation of study findings and the potential selection of multi-resistant microorganisms.
Conclusions:
- While SID can decrease early gram-negative infections, its overall benefit in liver transplantation is debated.
- The rise in gram-positive infections and the risk of promoting multi-resistant bacteria complicate the routine use of SID.
- Further research is needed to clarify the role and safety of SID in liver transplant recipients.
