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


  • 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



Surgical site infection, Liver transplantation, Care bundle


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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How to Cite

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: