BACTERIAL AND FUNGAL COLONIZATION AND INFECTIONS USING ORAL SELECTIVEBOWEL DECONTAMINATION IN ORTHOTOPIC LIVER TRANSPLANTATIONS

Bacterial and fungal infections are a major cause of morbidity and mor tality after orthotopic liver transplantation. In the immunocompromise d host, infections are thought to arise from the gut, which is almost always colonized with potential pathogens. Using oral selective bowel decontamination (SBD), potential pathogens can be eradicated from the gut and infections prevented. In this catamnestic study we have review ed gastrointestinal colonization, bacterial and fungal infections, and bacterial resistance to standard antibiotics in our first 206 liver t ransplant patients while under SBD. With few exceptions, gram-negative s were eradicated from the gastrointestinal tract and secondary coloni zation was inhibited. In spite of unsatisfactory elimination of Candid a, probably because nystatin doses were too low, Candida infections we re rare (n = 4) and none was fatal. One and two-year survival rates we re 93% and 92%, respectively. The bacterial and fungal infection rate was 27.8% with an infection-related mortality of 1.95%. Infections wit h aerobic gram-positive bacteria prevailed and only 11 gram-negative a nd 11 fungal infections occurred; among the latter, Aspergillus and Mu cor were the most serious and responsible for three of the six deaths in this series. With regard to the development of resistance, we found an increasing number of enterococci and coagulase-negative staphyloco cci resistant to ciprofloxacin and imipenem, respectively, but unlikel y as a consequence of SBD.