Risk factors associated with preoperative fecal carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae in liver transplant recipients.

ObjectiveThe aim of the study was to identify risk factors associated with pre-transplant fecal carriage of extended-spectrum -lactamase (ESBL)-producing Enterobacteriaceae in liver transplant recipients. Patients and methodsOver a 3-year period (January 2009-December 2011), 317 patients who underwent liver transplantation were screened preoperatively for fecal carriage of ESBL-producing Enterobacteriaceae. Risk factors for fecal carriage were investigated by univariate analysis and stepwise logistic regression. ResultsOf the 317 patients screened, 50 (15.7%) harbored an ESBL-producing isolate. Previous infection with an ESBL-producing organism had developed during the last 6months in 20% of fecal carriers versus in none of the non-carriers. Other variables associated with fecal carriage were a model for end-stage liver disease score 25, pre-transplant stay in the intensive care unit 48h, hospital stay 10days in the last 6months, a history of spontaneous bacterial peritonitis (SBP), exposure to a -lactam agent in the last month, and prophylaxis with norfloxacin. Independent predictors of fecal carriage in the multivariate logistic regression model were exposure to a -lactam agent in the month preceding transplantation (odds ratio [OR]=7.8, confidence interval [CI]=4-15.5, P<0.001), and a history of SBP (OR=2.4, CI=1.1-4.9, P=0.02). ConclusionsPrevious infection with an ESBL-producing isolate, recent exposure to a -lactam agent, and a history of SBP are risk factors for preoperative fecal carriage of ESBL-producing Enterobacteriaceae in liver transplant recipients. Patients at risk of fecal carriage should receive intraoperative prophylaxis and, when necessary, empiric postoperative antimicrobial treatment that includes coverage for these organisms.