BACTERIAL AND FUNGAL-INFECTIONS AFTER LIVER-TRANSPLANTATION - AN ANALYSIS OF 284 PATIENTS

A prospective study of bacterial and fungal infections after liver tra nsplantation in 284 adults was undertaken. One hundred seventy-five (6 2%) became infected; bacterial or fungal infections occurred in 159 (5 6%) and 36 (13%) patients, respectively. Gram-positive cocci, in parti cular Staphylococcus aureus and Enterococcus faecium, were the commone st bacterial pathogens, and bacteremia and wound infection were the mo st frequent bacterial infections. Acute rejection and prolonged admiss ion were independent risk factors for bacterial infection; pretranspla ntation antibacterials had a protective effect. Fungal infection most frequently involved the urinary tract and chest; Candida albicans was the most common pathogen. Four independent variables predicted fungal infection: low pretransplantation he. moglobin, high pretransplantatio n bilirubin, return to surgery, and prolonged therapy with ciprofloxac in. Patients with acute liver failure were more prone to bacterial, bu t not fungal, infection. No associations were found between infections and duration of surgery. Bacterial, and to a lesser extent, fungal in fections are important complications of liver transplantation. However , liver transplantation surgery per se may not be the major determinan t of infection.