LACTOBACILLEMIA IN LIVER-TRANSPLANT PATIENTS

Lactobacilemia is rare and, to our knowledge, previously undescribed i n liver transplant patients. We reviewed the clinical records of all p atients who had undergone orthotopic liver transplantation between Jan uary 1985 and August 1992 for whom a blood culture after transplantati on yielded Lactobacillus species. A case-control study for determinati on of risk factors for lactobacillemia in this patient population was also performed. Eight cases of lactobacillus bacteremia were identifie d. All patients received nonabsorbable oral antibiotics for selective bowel decontamination. In addition, six of eight case patients receive d intravenous vancomycin prior to the development of lactobacillemia. The biliary anastomosis in each case patient was a Roux-en-Y choledoch ojejunostomy. Analysis of the case-control study revealed that the pre sence of a Roux-en-Y choledochojejunostomy at the time of lactobacille mia is a statistically significant risk factor (odds ratio [OR] = infi nity, 95% confidence interval [CI] = 1.8-infinity, P less than or equa l to .05) but that prior administration of intravenous vancomycin is n ot a statistically significant risk factor (OR = 2.6, 95% CI = 0.38-30 .0, P value not significant) for lactobacillemia. The use of selective bowel decontamination and of intravenous vancomycin in liver transpla nt patients may select for Lactobacillus species. Furthermore, a Roux- en-Y choledochojejunostomy may allow colonization of the intrahepatic biliary tract with enteric flora.