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Surgical Site Infections After Pediatric Liver Transplantation-Impact of a Change in Perioperative Prophylactic
Nora Bruns1,2, Juliane Hauschild1, Elke Lainka3
1Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Insights
Surgical site infections (SSIs) in pediatric liver transplant patients are complex. Longer perioperative antibiotic prophylaxis (PAP) duration may reduce SSIs, but abdominal patch placement increases risk.
Area of Science:
- Pediatric surgery
- Transplantation immunology
- Infectious disease
Background:
- Infections are a significant cause of morbidity and mortality after pediatric liver transplantation.
- Understanding factors influencing surgical site infections (SSIs) is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the impact of perioperative antibiotic prophylaxis (PAP) type and duration on SSIs in pediatric liver transplant recipients.
- To identify risk factors associated with SSIs in this patient population.
Main Methods:
- Retrospective analysis of 125 pediatric liver transplant patients (2014-2020).
- Patients categorized into two periods based on PAP regimen changes.
- Multivariable regression models used to assess risk factors, including PAP duration, antibiotic choice, and abdominal patch placement.
Main Results:
- SSIs occurred in 19% of analyzed patients; the PAP regimen change did not significantly impact SSI rates.
- Abdominal patch placement was a significant risk factor for SSIs (OR 3.81).
- Longer PAP duration was associated with a reduction in SSIs, with diminishing effect over time.
Conclusions:
- Current PAP regimens may not be fully optimized for pediatric liver transplant patients.
- SSI occurrence is multifactorial, influenced by factors beyond PAP.
- Evidence-based, tailored PAP strategies and multicentric research are needed to prevent SSIs in this vulnerable group.
Background:
In spite of improved survival rates after pediatric liver transplantation, infections remain major contributors to perioperative morbidity and mortality. This study aimed to understand the impact of type and duration of perioperative antibiotic prophylaxis (PAP) on the occurrence of surgical site infections (SSIs).
Methods:
In total, 125 patients who underwent liver transplantation between 2014 and 2020 were retrospectively included. Patients were categorized into two periods based on changes in the standard PAP regimen. Risk factors for SSIs were investigated, including the influence of PAP duration, antibiotic substances used, and abdominal patch placement using multivariable regression models.
Results:
SSIs occurred in 23 (19%) of 119 analyzed patients and were not impacted by changes in the PAP regimen. The placement of an abdominal patch was a relevant risk factor for SSIs (odds ratio 3.81; 95% confidence interval [CI] 1.15-12.68). Longer PAP duration reduced the occurrence of SSIs by up to 4.6 percentage points (95% CI 0.0-9.1) per day, with its effect diminishing with longer duration. The choice of antibiotic substances for PAP changed after implementation of the new protocol, with a decline in vancomycin usage from 14% to 3%.
Conclusion:
The results of this study emphasize the need for evidence-based PAP regimens tailored to the unique needs of pediatric liver transplant recipients. The occurrence of SSIs remains complex and is influenced by various factors beyond the PAP regimen. Multicentric efforts to develop effective prevention strategies against SSIs in this vulnerable population are warranted.
