Surgical Site Infections in Post-Living Donor Liver Transplantation: Surveillance and Evaluation of Care Bundle Approach

Authors

  • Mona Wassef Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
  • Reham H. A. Yousef Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
  • Marwa Mahmoud Hussein Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
  • Mostafa A. El-Shazly Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
  • Doaa M. Ghaith Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt

DOI:

https://doi.org/10.3889/oamjms.2022.10155

Keywords:

Surgical site infection, Liver transplantation, Care bundle

Abstract

Background and Aim: Although implantation of a care bundle approach is well established in intensive care units (ICUs), yet its impact on reducing surgical site infections (SSI) among post living-donor-liver transplantation (LDLT) patients has not been established. Our aim is to evaluate the impact of a care bundle in reducing SSI and to detect the pattern of antibiotic resistance in LDLT. Materials and Methods: This before and after comparative study was conducted at Elmanial specialized tertiary hospital, Cairo University over a period of 3 years (January 2016 - December 2018) including 57 LDLT patients. We introduced a care bundle comprised of a group of evidence-based practices implemented together. The study was divided into three phases. All bacterial identification and antibiotic sensitivity testing were done by a Vitek 2 compact system. Results: SSIs rates were reduced significantly by 30.4% from the pre-implementation to the post implementation phase (from 13/24, 54.2% to 5/21, 23.8%, OR 0.21, CI 95%: 1.137- 0.039). This reduction went hand in hand with increase in the hand hygiene compliance from 57.3 % to 78 %, then remained sustained with a median rate of 78% in the last 6 months. Klebsiella pneumoniae 11\25 (44% of SSIs), Acinetobacter baumannii 8\25 (32% of SSIs), Escherichia coli 5\25 (20%), Pseudomonas aeruginosa 5\25 (20%) and MRSA 4\25 (16%). With predominance of XDR phenotype 14/25 (56%), followed by ESBL of gram-negative bacteria 6/25 (24%), then MRSA 4/25 (16%). Conclusion: SSIs in LDLT mandates strict implementation of comprehensive evidence-based care bundles for better patent outcome.

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References

Pouladfar G, Jafarpour Z, Hosseini SA, Firoozifar M, Rasekh R, Khosravifard L. Bacterial infections in pediatric patients during early post liver transplant period: A prospective study in Iran. Transpl Infect Dis. 2018;21(1):e13001. https://doi.org/10.1111/tid.13001 PMid:30221820 DOI: https://doi.org/10.1111/tid.13001

Freire MP, Oshiro IC, Bonazzi PR, Guimarães T, Figueira ER, Bacchella T, et al. Surgical site infections in liver transplant recipients in the model for end-stage liver disease era: An analysis of the epidemiology, risk factors, and outcomes. Liver Transpl. 2013;19(9):1011-9. https://doi.org/10.1002/lt.23682 PMid:23744748 DOI: https://doi.org/10.1002/lt.23682

Mukhtar A, Abdelaal A, Hussein M, Dabous H, Fawzy I, Obayah G, et al. Infection complications and pattern of bacterial resistance in living-donor liver transplantation: A multicenter epidemiologic study in Egypt. Transplant Proc. 2014;46(5):1444-7. https://doi.org/10.1016/j.transproceed.2014.02.022 PMid:24935311 DOI: https://doi.org/10.1016/j.transproceed.2014.02.022

El-Meteini M, Fayez A, Fathy M, Abdalaal A, Safaan H, Mostafa I, et al. Living related liver transplantation in Egypt: An emerging program. Transplant Proc. 2003;35(7):2783-6. https://doi.org/10.1016/j.transproceed.2003.09.052 PMid:14612119 DOI: https://doi.org/10.1016/j.transproceed.2003.09.052

Wassef M, Mukhtar A, Nabil A, Ezzelarab M, Ghaith D. Care bundle approach to reduce surgical site infections in acute surgical intensive care unit, Cairo, Egypt. Infect Drug Resist. 2020;13:229-36. https://doi.org/10.2147/idr.s236814 PMid:32095080 DOI: https://doi.org/10.2147/IDR.S236814

CDC/NHSN Surveillance Definition of Health Care-associated Infection and Criteria for Specific Types of Infections in the Acute Care Setting. Atlanta: CDC; 2019. Available from: https://www.cdc.gov/nhsn [Last accessed on 2020 May 30].

Horan T, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32. https://doi.org/10.1016/j.ajic.2008.03.002 PMid:18538699 DOI: https://doi.org/10.1016/j.ajic.2008.03.002

Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268-81. https://doi.org/10.1111/j.1469-0691.2011.03570.x PMid:21793988 DOI: https://doi.org/10.1111/j.1469-0691.2011.03570.x

Clinical and Laboratory Standards Institute. M100-S27. Performance Standards for Antimicrobial Susceptibility Testing: In: 27th Informational Supplement. Wayne, PA: CLSI; 2017.

Prado ME, Matia EC, Ciuro FP, Díez-Canedo JS, Martín JM, López FM, et al. Surgical site infection in liver transplant recipients: Impact of the type of perioperative prophylaxis. Transplantation. 2008;85(12):1849-54. https://doi.org/10.1097/tp.0b013e3181735407 PMid:18580480 DOI: https://doi.org/10.1097/TP.0b013e3181735407

Anesi JA, Blumberg EA, Abbo LM. Perioperative antibiotic prophylaxis to prevent surgical site infections in solid organ transplantation. Transplantation. 2018;102(1):21-34. https://doi.org/10.1097/tp.0000000000001848 PMid:28614192 DOI: https://doi.org/10.1097/TP.0000000000001848

Lin M, Mah A, Wright AJ. Infectious complications of liver transplantation. AME Med J. 2018;3:5-5. https://doi.org/10.21037/amj.2017.12.10 DOI: https://doi.org/10.21037/amj.2017.12.10

Parekh JR, Greenstein S, Sudan DL, Grieco A, Cohen ME, Hall BL, et al. Beyond death and graft survival variation in outcomes after liver transplant. Results from the NSQIP transplant beta phase. Am J Transplant. 2019;19(7):2108-15. https://doi.org/10.1111/ajt.15357 PMid:30887634 DOI: https://doi.org/10.1111/ajt.15357

Viehman JA, Clancy CJ, Clarke L, Shields RK, Silveira FP, Kwak EJ, et al. Surgical site infections after liver transplantation: Emergence of multidrug-resistant bacteria and implications for prophylaxis and treatment strategies. Transplantation. 2016;100(10):2107-14. https://doi.org/10.1097/tp.0000000000001356 PMid:27479167 DOI: https://doi.org/10.1097/TP.0000000000001356

Perkins KM, Reddy SC, Fagan R, Arduino MJ, Perz JF. Investigation of healthcare infection risks from water-related organisms: Summary of CDC consultations, 2014-2017. Infect Control Hosp Epidemiol. 2019;40(6):621-6. https://doi.org/10.1017/ice.2019.60 PMid:30942147 DOI: https://doi.org/10.1017/ice.2019.60

Moreno A, Cervera C, Gavalda J, Rovira M, De La Cámara R, Jarque I, et al. Bloodstream infections among transplant recipients: Results of a nationwide surveillance in Spain 1. Am J Transplant. 2007;7(11):2579-86. https://doi.org/10.1111/j.1600-6143.2007.01964.x PMid:17868067 DOI: https://doi.org/10.1111/j.1600-6143.2007.01964.x

Yamamoto M, Takakura S, Iinuma Y, Hotta G, Matsumura Y, Matsushima A, et al. Changes in surgical site infections after living donor liver transplantation. PLoS One. 2015;10(8):e0136559. https://doi.org/10.1371/journal.pone.0136559 DOI: https://doi.org/10.1371/journal.pone.0136559

Softness KA, El Sabbagh A, Kroemer A, Hawksworth J, Matsumoto CS. Surgical site infection after liver transplantation: Single-center experience. Int J Transplant Res Med. 2018;4:37. https://doi.org/10.23937/2572-4045.1510037 DOI: https://doi.org/10.23937/2572-4045.1510037

Helal S, El Anany M, Ghaith D, Rabeea S. The role of MDR-acinetobacter baumannii in orthopedic surgical site infections. Surg Infect (Larchmt). 2015;16(5):518-22. https://doi.org/10.1089/sur.2014.187 PMid:26114551 DOI: https://doi.org/10.1089/sur.2014.187

Hasanin A, Eladawy A, Mohamed H, Salah Y, Lotfy A, Mostafa H, et al. Prevalence of extensively drug-resistant gram negative bacilli in surgical intensive care in Egypt. Pan Afr Med J. 2014;19. https://doi.org/10.11604/pamj.2014.19.177.4307 PMid:25815098 DOI: https://doi.org/10.11604/pamj.2014.19.177.4307

Ghaith DM, Mohamed ZK, Farahat MG, Shahin WA, Mohamed HO. Colonization of intestinal microbiota with carbapenemase-producing Enterobacteriaceae in paediatric intensive care units in Cairo, Egypt. Arab J Gastroenterol. 2019;20(1):19-22. https://doi.org/10.1016/j.ajg.2019.01.002 PMid:30733176 DOI: https://doi.org/10.1016/j.ajg.2019.01.002

Hasanin A, Mukhtar A, El-adawy A, Elazizi H, Lotfy A, Nassar H, et al. Ventilator associated pneumonia caused by extensive-drug resistant Acinetobacter species: Colistin is the remaining choice. Egypt J Anaesth. 2016 Jul 1;32(3):409-13. https://doi.org/10.1016/j.egja.2016.03.004 DOI: https://doi.org/10.1016/j.egja.2016.03.004

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Published

2022-08-05

How to Cite

1.
Wassef M, Yousef RHA, Hussein MM, El-Shazly MA, Ghaith DM. Surgical Site Infections in Post-Living Donor Liver Transplantation: Surveillance and Evaluation of Care Bundle Approach. Open Access Maced J Med Sci [Internet]. 2022 Aug. 5 [cited 2024 Apr. 18];10(A):1411-6. Available from: https://oamjms.eu/index.php/mjms/article/view/10155