Impact of Extended versus Short Course Peri-operative Antibiotics on Surgical Site Infection in Liver Transplant Patients
Author(s):
Puja Shah, University of Virginia; Laura Rosenberger, Memorial Sloan Kettering; Christopher Guidry, University of Virginia; Robert Sawyer, University of Virginia HSC
Background: The appropriate duration of surgical antibiotic prophylaxis in orthotopic liver transplant (OLT) is unclear, and an extended course of perioperative antibiotics may provide protection against infections specifically among these immunocompromised patients.
Hypothesis: We hypothesized that 72 hours of peri-operative antibiotic prophylaxis would decrease rates of surgical site infection (SSI) in an OLT population when compared to intra-operative antibiotic prophylaxis alone.
Methods: We randomized OLT recipients to receive either 72 hours of perioperative antibiotics (extended antibiotics- EA) or intra-operative antibiotics only (short antibiotics- SA). Continuous variables were analyzed using Student’s T-test or Wilcoxon’s Rank Sum, and categorical variables were analyzed with Chi-square test. Kaplan-Meier analysis identified time to infection for the two arms.
Results: 102 patients were randomized—52 to the EA and 50 to SA. Randomization was successful for age, gender, body mass index, race, model for end stage liver disease scores, pre-operative steroid use, and patients on maintenance antibiotics. Rates of SSI and nosocomial infection (NI) were lower in the SA group, though these differences were not statistically significant (Table). Piperacillin-tazobactam was administered to 66% of all patients needing additional antibiotics. Intensive care unit (ICU) lengths of stay (LOS), hospital LOS, 30-day mortality, and time to infection were also similar between the two groups. Patients developing infection had longer ICU LOS, hospital LOS and a higher association with re-operation, ERCP, and 30-day readmission (Table).
Conclusions: Contrary to our hypothesis, extending the course of peri-operative antibiotics to 72 hours from intra-operative dosing alone in OLT patients does not appear to decrease the incidence of SSI or NI. Although a larger, multicenter, randomized trial is required to verify these results, our data imply that the likelihood of finding a clinically relevant difference is low. These results suggest that it is acceptable for OLT recipients to receive intra-operative antibiotic prophylaxis alone.