THE SIGNIFICANCE OF AEROBIC GRAM-NEGATIVE BACILLI IN CLINICAL SPECIMENS FOLLOWING ORTHOTOPIC LIVER-TRANSPLANTATION

In a prospective study of 284 liver transplant patients, we sought ass ociations between aerobic gram-negative bacillus acquisition or infect ion and 35 preoperative, perioperative, and postoperative variables. A lthough the 128 (45%) who acquired aerobic gram-negative bacilli had l onger admissions (P = 0.0001), no associations were found with pretran splant variables. Fifty-three (41%) of the 128 acquired coliforms (e.g ., Escherichia coil, Klebsiella spp,, or Enterobacter spp.), 50 (39%) acquired nonfermentative bacilli (e.g., Acinetobacter spp., Pseudomona s spp., or Stenotrophomonas maltophilia), and a further 25 (20%) acqui red both. Acquisition progressed to infection in 58% of patients who a cquired coli-forms but in only 18% of patients who acquired nonferment ative bacilli (P = 0.005), Acinetobacter spp, were isolated from more patients than other bacilli but rarely caused infection, The positive predictive values for infection of acquiring coliforms or nonfermentat ive bacilli in clinical material were 42% and 17%, respectively. This study allowed us to determine for each clinical site the positive pred ictive values for infection of acquisition of different aerobic gram-n egative bacilli. Our results should contribute to the rationalization of antimicrobial prescribing for this patient group. Copyright (C) 199 8 by the American Association for the Study of Liver Diseases.