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Transplant Proc. 2019 Mar;51(2):457-460. doi: 10.1016/j.transproceed.2019.01.077. Epub 2019 Jan 28.

Perioperative Chemoprophylaxis οr Treatment for Extensively Drug Resistant Gram-Negative Bacteria in Patients Undergoing Liver Transplantation Based on Preoperative Donor/Recipient Surveillance Cultures: A Prospective Study.

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Intensive Care Unit, Hippokratio General Hospital, Thessaloniki, Greece. Electronic address:
Intensive Care Unit, Hippokratio General Hospital, Thessaloniki, Greece.
Infectious Diseases Section, 3rd Department of Pediatrics, Hippokratio General Hospital, Medical School Aristotle University of Thessaloniki, Thessaloniki, Greece.
Division of Transplantation, Department of Surgery, Hippokratio General Hospital, Medical School Aristotle University of Thessaloniki, Thessaloniki, Greece.
Biopathology Laboratory Unit, Hippokratio General Hospital, Thessaloniki, Greece.
Anesthesiology Department, University Hospital "AHEPA," Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece.



The importance of preoperative donor/recipient colonization or donor infection by extensively drug-resistant Gram-negative bacteria (XDR-GNB) and its relation to serious post-transplantation infection pathogenicity in liver transplantation (LT) patients has not been clarified.


Prevention of postoperative infection due to XDR-GNB with the appropriate perioperative chemoprophylaxis or treatment based on preoperative donor/recipient surveillance cultures in LT patients, as well as their outcome.


Twenty-six patients (20 male, 6 female) were studied (average preoperative Model for End-Stage Liver Disease score ≈15, range: 8-29) from January 2017 to January 2018. In all patients, blood, urine, and bronchial secretions culture samples as well as a rectal colonization culture were taken pre- and postoperatively, once weekly after LT, and after intensive care unit discharge. Recipients with positive XDR-GNB colonization and patients receiving a transplant from a donor with an XDR-GNB positive culture or colonization received the appropriate chemoprophylaxis one half hour preoperatively according to culture results. De-escalation of the antibiotic regimen was done in 2 to 5 days based on the colonization/culture results of the donor and recipient and their clinical condition. Evaluation for serious infection was done at 1 week and at 28 days for outcome results.


Fourteen out of 26 recipients (53.8%) were positive for XDR-GNB colonization preoperative, with 2/14 (14.28%) presenting serious infection due to the same pathogen. Intensive care unit length of stay was significantly longer in colonized with XDR-GNB patients (P < .0001). The outcome of colonized patients was 6/14 (42.8%) expired, but only in 2/14 (14.2%) was mortality attributable to infection.


Administering appropriate perioperative chemoprophylaxis and treatment may limit the frequency of XDR-GNB infections and intensive care unit length of stay and may improve the outcome in LT recipients.

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