Methicillin-resistant Staphylococcus aureus carriers are vulnerable to bloodstream infection after living donor liver transplantation.

Abstract

Bloodstream infection (BSI) is a life-threatening complication after living donor liver transplantation (LDLT). We aimed to explore the incidence and predisposing factors of BSI at our institution. We conducted a retrospective cohort analysis on all consecutive adults with BSI within 6months after LDLT performed between 2005 and 2016. For antimicrobial prophylaxis, ampicillin/sulbactam, cefotaxime, and micafungin were administered. From 2011, methicillin-resistant Staphylococcus aureus (MRSA) carriers were decolonized using mupirocin ointment and chlorhexidine gluconate soap. Risk factors for BSI were identified by uni- and multivariate logistic regression. Of a total of 106 LDLTs, 42 recipients (40%) suffered BSI. The BSI group demonstrated significantly higher in-hospital mortality rates compared with the non-BSI group (24% vs. 7%, P=.01). We identified MRSA carrier (odds ratio [OR], 19.1; P<.001), ABO incompatibility (OR, 2.9; P=.03), and estimated glomerular filtration rate <30mL/min/1.73m2 (OR, 15.8; P=.02) as independent risk factors for BSI. Decolonization treatment for MRSA carriers did not reduce the incidence of all-cause BSI but reduced the frequency of BSI caused by MRSA. To our knowledge, for the first time, MRSA carriers were revealed to be highly vulnerable to BSI after LDLT.