# 309. Multidrug-Resistant Organism Colonisation and Surgical Site Infections Following Liver Transplantation

## TL;DR

This study found that multidrug-resistant organism colonization in liver transplant patients does not increase surgical site infection risk, and targeted antibiotics do not reduce it either.

## Contribution

The study is the first to show that MDRO colonization and targeted antibiotics do not independently affect SSI risk after liver transplantation.

## Key findings

- MDRO colonization was not associated with increased SSI risk after liver transplantation.
- Targeted perioperative antibiotics for MDRO did not reduce SSI risk in colonized patients.
- Post-operative biliary complications and haemodialysis were significant risk factors for SSIs.

## Abstract

Liver transplant (LTx) recipients are at increased risk of surgical site infections (SSIs). We explored potential risk factors for SSIs post-LTx including colonisation with multidrug-resistant organisms (MDRO) and aimed to assess the impact of perioperative antibiotics targeted at colonising MDRO on the subsequent risk of SSI.

A retrospective analysis of adults undergoing LTx at a tertiary referral centre between 2015–2022 was conducted. MDRO colonisation status was determined by routine rectal screening for MDRO including vancomycin-resistant enterococci and extended-spectrum beta-lactamase-producing (ESBL) and carbapenemase-producing Enterobacterales (CPE) at time of LTx. The primary outcome was SSI defined using CDC/NHSN criteria. Clinical features related to the patient and donor organ were retrieved from medical records. A multivariable analysis was conducted to evaluate the impact of MDRO colonisation and targeted antibiotics on 30-day SSI risk.

Of 462 patients who underwent LTx, 157/462 (34.0%) were colonised with MDRO (131 [28.4%] VRE and 38 [8.4%] ESBL/AmpC/CPE). The 30-day SSI rate was 11.9% (55/462), including 16.4% superficial, 5.2% deep incisional and 78.4% organ-space infections. Post-operative biliary complications (aOR 2.1 95% CI 0.98-4.27; P=0.048) and post-LTx haemodialysis (aOR 3.84; 95% CI 1.75-8.17, P= 6e-04) were significantly associated with increased SSI risk on multivariable analysis. There was no association between MDRO colonisation and risk of SSI following LTx (aOR 1.47; 95% CI 0.79-2.71, P=0.2195)). Among MDRO colonised patients (n=157), the use of perioperative antibiotics targeted at colonising MDRO was not associated with reduced SSI risk (aOR 0.40; 95% CI 0.08-1.4; P=0.189).

SSIs following LTx most commonly involve deep organ spaces. MDRO colonisation was not independently associated with an increased SSI risk, and receiving directed-perioperative antibiotic prophylaxis did not decrease SSI risk.

All Authors: No reported disclosures

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Source: https://tomesphere.com/paper/PMC12792618