Selective decontamination of the digestive tract helps prevent bacterial infections in the early postoperative period after liver transplant

In liver transplant (LTx) recipients, gut-associated bacterial and fungal o rganisms produce significant postoperative morbidity and mortality. We soug ht to assess the role of selective digestive decontamination (SDD) in preve nting postoperative infections in a large single-center cohort of liver rec ipients transplanted under two non-simultaneous protocols. In 212 consecuti ve patients transplanted between 1/1/91 and 7/31/92, SDD (gentamicin 80 mg, polymyxin B 100 mg, nystatin suspension 10 mt) was employed, starting afte r induction of anesthesia and continued until POD 21 (SDD Group). In 157 co nsecutive patients transplanted between 1/1/93 and 12/31/93, SDD was not us ed (non-SDD Group). Both groups received IV vancomycin and cefotaxime proph ylaxis. All culture-positive infections within the first 30 days post-LTx w ere recorded and classified as bacterial or fungal. Infection-related morta lity (patients who died of infectious complications without any technical c omplication) was recorded. Groups did not differ in patient demographics, U nited Network for Organ Sharing (UNOS) status, use of veno-venous bypass, t otal/warm ischemia, or length of ICU stay. Infections developed in fewer SD D patients (56/212; 26%) than non-SDD patients (69/157; 44%) (p<0.001). The incidence of gram-negative infection was less in the SDD group (11% vs. 26 %, p<0.001) as was gram-positive infection (16% vs. 26%, p<0.001). Among pa tients who developed infection, there was no difference between groups in i nfections per patient. Primary graft non-function (PNF) developed in 20 SDD patients (7/20 had infections) and 8 non-SDD patients (6/8 had infections) (p=0.06). There were no differences in incidence of fungal infections or o f infection-related mortality between groups. In the SDD group, there were fewer abdominal (p<0.001), lung (p<0.001), wound (p<0.01), and urinary trac t infections (p<0.05). Conclusion: Use of SDD in liver recipients early after transplant was assoc iated with significantly fewer infections in the early postoperative period .