Risk Factors and Impact of Perioperative Prophylaxis on the Risk of Extended-spectrum β-Lactamase-producing Enterobacteriaceae-related Infection Among Carriers Following Liver Transplantation.

BACKGROUND: ESBL-E (Extended-Spectrum beta-Lactamase-producing Enterobacteriaceae) carriage is frequent among liver transplant (LT) recipients, thereby fostering a large empirical carbapenem prescription. However, ESBL-E infections occur in only 10-25% of critically ill patients with rectal colonization. Our aim was to identify risk factors for post-LT ESBL-E infection in colonized patients. The effect of perioperative antimicrobial prophylaxis (AP) was also analyzed in patients with prophylaxis lasting less than 48 hours and without proven intraoperative infection. METHODS: Retrospective study from a prospective database including patients with a positive ESBL-E rectal screening transplanted between 2010 and 2016. RESULTS: Among the 749 patients transplanted, 100 (13.3%) were colonized with an ESBL-E strain. 39 (39%) patients developed an infection related to the same ESBL-E (10 pulmonary, 11 surgical site, 13 urinary, 5 bloodstream) within 11 postoperative days in median. K. pneumoniae carriage, MELD >/= 25, preoperative spontaneous bacterial peritonitis prophylaxis and antimicrobial exposure during the previous month were independent predictors of ESBL-E infection. We propose a Colonization To Infection (CTI) risk score built on these variables. The prevalence of infection for CTI score of 0, 1, 2 and >/=3 were 7.4%, 26.3%, 61.9% and 91.3% respectively. Of note, the incidence of post-LT ESBL-E infection was lower in case of perioperative AP targeting colonizing ESBL-E (p=0.04). CONCLUSIONS: 39% of ESBL-E carriers develop a related infection after LT. We identified predictors for ESBL-E infection in carriers that may help in rationalizing carbapenem prescription. Perioperative AP targeting colonizing ESBL-E may be associated with a reduced risk of post-LT ESBL-E infections.