Abstract
BackgroundThe incidence and risk factors of methicillin-resistant Staphylococcus aureus (MRSA) acquisition after living donor liver transplantation (LDLT) are unclear. The aim of the present study was to assess the incidence and to analyze the risk factors for the acquisition of MRSA after LDLT in adults by multivariate analysis.MethodsWe retrospectively reviewed the data from 158 adult patients that underwent LDLT at the Tokyo University Hospital. The microbiologic and medical records of the patients from admission to 3 months after LDLT were reviewed. Uni- and multivariate analyses were performed to identify the risk factors for postoperative acquisition of MRSA.ResultsPostoperative MRSA acquisition was detected in 35 of 158 patients by median postoperative day 18. Age (>= 60 y) and perioperative dialysis and/or apheresis predicted postoperative MRSA acquisition by multivariate analysis. In contrast, postoperative use of fluoroquinolone was negatively associated with acquisition of MRSA.ConclusionMRSA arose early after LDLT in adults with a high incidence (35 of 158 patients). Surveillance culture should be checked periodically after LDLT to identify and prevent the transmission of MRSA.
Highlights
The incidence and risk factors of methicillin-resistant Staphylococcus aureus (MRSA) acquisition after living donor liver transplantation (LDLT) are unclear
Preoperative MRSA carriage is associated with an increased risk of MRSA infection after deceased donor liver transplantation (DDLT) [1,3,4,5]
Positive MRSA culture in postoperative as well as in preoperative surveillance is important because the finding of MRSA colonization in a patient during hospitalization increases the risk of MRSA infection [6]
Summary
The incidence and risk factors of methicillin-resistant Staphylococcus aureus (MRSA) acquisition after living donor liver transplantation (LDLT) are unclear. BMC Infectious Diseases 2008, 8:155 http://www.biomedcentral.com/1471-2334/8/155 tion in patients who had MRSA colonization was higher than that in patients who were not colonized with Staphylococcus aureus In this particular study, 12 of 394 patients had MRSA colonization during hospitalization, and 4 of 12 (25%) later developed MRSA infection. Background and clinical data collected for each patient included: 1) preoperative variables (age, gender, etiology of the underlying liver disease, presence of hepatocellular carcinoma, Child-Pugh score, MELD score, presence of ascites, use of diuretics, presence of encephalopathy, the international normalized ratio of prothrombin time level, serum bilirubin level [mg/dl], serum albumin level [g/dl], serum creatinine level [mg/dl], use of steroid, use of antimicrobials during the month before LDLT, presence of diabetes mellitus, history of hospital stay during the 6 months before LDLT, and methicillin-susceptible Staphylococcus aureus colonization; 2) surgical variables (operation time [hours], estimated blood loss [ml], blood transfusion [ml], graft volume/ standard liver volume ratio [%], and application of duct to duct biliary reconstruction; 3) postoperative variables (length of urinary catheter insertion [days], length of arterial catheter insertion [days], length of central venous catheter insertion [days], length of endotracheal tube insertion [days], necessity for reoperation, acute rejection, cytomegalovirus infection, fungal infection, and postoperative use of antimicrobials other than the routine perioperative prophylaxis); and
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