High Mortality and Antimicrobial Resistance: Challenges of Bloodstream Infections in Liver Transplant Recipients

Bloodstream infections (BSIs) are one of the most frequent complications among liver transplant recipients and are associated with a markedly increased risk of death. Our study aims to define the incidence, epidemiology and clinical characteristics of BSIs after liver transplantation (LT) and to investigate risk factors related to 30-day mortality.

We considered all patients who underwent LT at the Università Politecnica delle Marche of Ancona for up to 10 years and selected those who experienced at least one episode of BSI.

Out of 601 LT recipients, 96 had at least one episode of BSI. Most BSIs occurred within the first month post-transplantation. Central vascular catheter infections were the most frequent source, followed by surgical site infections, pneumonia, and urinary tract infections. Overall, we isolated 102 microorganisms: 66% were Gram-negative bacteria, 30% Gram-positive bacteria and 4% fungi. High rates of antimicrobial resistance were observed among both Gram-negative (34%) and Gram-positive bacteria (84%).Thirty-day mortality was 26%, with septic shock (HR 226.980 [CI 95% 5.083-10135.347], p=0.005), the absence of invasive procedures within 72 hours before BSI onset (HR 88.567 [CI 95% 2.484-357.754], p=0.014), white blood cell count ≥ 2,500/mmc (HR 34.948 [CI 95% 1.568-778.750], p=0.025), creatinine >1.02 mg/dl (HR 13.982 [CI 95% 1.487-131.485], p=0.021] and hypoalbuminemia (HR 24.775 [CI 95% 1.371-447.744], p=0.030) being significant risk factors.

This study provides detailed insights into post-transplant BSIs, highlighting the alarming rates of antimicrobial resistance, thereby suggesting a major effort to rationalize the use of antimicrobial therapy.