Multidrug-Resistant Organism Colonisation and Surgical Site Infections Following Liver Transplantation

Abstract Background Liver transplant (LTx) recipients are at increased risk of surgical site infections (SSIs). We explored potential risk factors for SSIs post-LTx including colonisation with multidrug-resistant organisms (MDRO) and aimed to assess the impact of perioperative antibiotics targeted at colonising MDRO on the subsequent risk of SSI. Methods A retrospective analysis of adults undergoing LTx at a tertiary referral centre between 2015–2022 was conducted. MDRO colonisation status was determined by routine rectal screening for MDRO including vancomycin-resistant enterococci and extended-spectrum beta-lactamase-producing (ESBL) and carbapenemase-producing Enterobacterales (CPE) at time of LTx. The primary outcome was SSI defined using CDC/NHSN criteria. Clinical features related to the patient and donor organ were retrieved from medical records. A multivariable analysis was conducted to evaluate the impact of MDRO colonisation and targeted antibiotics on 30-day SSI risk. Results Of 462 patients who underwent LTx, 157/462 (34.0%) were colonised with MDRO (131 28.4% VRE and 38 8.4% ESBL/AmpC/CPE). The 30-day SSI rate was 11.9% (55/462), including 16.4% superficial, 5.2% deep incisional and 78.4% organ-space infections. Post-operative biliary complications (aOR 2.1 95% CI 0.98-4.27; P=0.048) and post-LTx haemodialysis (aOR 3.84; 95% CI 1.75-8.17, P= 6e-04) were significantly associated with increased SSI risk on multivariable analysis. There was no association between MDRO colonisation and risk of SSI following LTx (aOR 1.47; 95% CI 0.79-2.71, P=0.2195)). Among MDRO colonised patients (n=157), the use of perioperative antibiotics targeted at colonising MDRO was not associated with reduced SSI risk (aOR 0.40; 95% CI 0.08-1.4; P=0.189). Conclusion SSIs following LTx most commonly involve deep organ spaces. MDRO colonisation was not independently associated with an increased SSI risk, and receiving directed-perioperative antibiotic prophylaxis did not decrease SSI risk. Disclosures All Authors: No reported disclosures