Selective bowel decontamination to decrease gram-negative aerobic bacterial and Candida colonization and prevent...

Area of Science:

• Transplantation Medicine
• Infectious Diseases
• Gastroenterology

Background:

• Gram-negative bacterial and fungal infections pose significant risks for liver transplant recipients.
• Endogenous sources of pathogens in the gut contribute to post-transplant infections.

Purpose of the Study:

• To evaluate the efficacy of selective bowel decontamination (SBD) in reducing gram-negative bacteria and Candida colonization.
• To assess the impact of SBD on the incidence of infections in liver transplant patients.

Main Methods:

• Administered nonabsorbable antibiotics (Polymixin E, gentamicin, Nystatin) and a low-bacterial diet for 21 days post-transplant.
• Conducted surveillance cultures of the throat, rectum, trachea, wound, blood, and bile.
• Monitored for gram-negative bacteria and Candida colonization and infection.

Main Results:

• Baseline colonization rates were high: 97% for gram-negative bacteria and 53% for Candida.
• SBD rapidly eliminated gastrointestinal and oropharyngeal colonization: 87% gram-negative free and 100% Candida free within 3 days.
• No gram-negative infections were observed in the first 30 days post-transplant.

Conclusions:

• Selective bowel decontamination effectively reduces gram-negative aerobic bacteria and Candida colonization in liver transplant recipients.
• SBD appears to decrease the incidence of early post-transplant infections caused by these organisms.
• Rapid recolonization necessitates further investigation into sustained decontamination strategies.