Lunes, 20 Mayo 2019 15:29

Impact of a Multimodal Approach in Prevention of Surgical Site Infection in Hepatic Transplant Recipients.

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 Revista Internacional 

Prieto JMedina JCLópez MRando KIglesias CHarguindeguy MLeites AEtlin AMenéndez JValverde MScalone PCastelli JGrecco GAbelleira MGonzález LSGerona S. Impact of a Multimodal Approach in Prevention of Surgical Site Infection in Hepatic Transplant Recipients. Transplant Proc. 2016 Mar;48(2):658-64.

INTRODUCTION:

In liver transplant (LT) recipients, surgical site infection (SSI) represents an important cause of morbidity and mortality.

OBJECTIVE:

This study measures the impact of a multimodal approach to the incidence of surgical site infection in LT recipients.

MATERIALS AND METHODS:

All of the LT recipients in our department were registered on the national database in solid organ transplant. A study was performed in two analytical-interventional phases. Phase 1 took place between July 14, 2009, and February 20, 2014. Phase 2 took place between February 21, 2014, and July 15, 2015. The multimodal change implemented during phase 1 was that 0.5% alcoholic chlorhexidine and ether were applied to the surgical field; surgical prophylaxis was primarily with ampicillin/sulbactam plus cefazolin. In phase 2, 2% alcoholic chlorhexidine alone was applied to the surgical field. The prior standard prophylaxis was changed to piperacillin tazobactam administered during surgery as a continuous infusion of 13.5 g over 8 hours with a pre-incision loading dose of 4.5 g. The loading dose of piperacillin tazobactam was combined with a single dose of gentamicin of 5 mg/kg.

RESULTS:

One hundred eight patients have received transplants since the start of the program: 82 patients during phase one and 26 patients during phase two. During phase 1, 13 cases of SSI were recorded, representing a rate of 15.85 per 100 transplants. Sixteen micro-organisms were isolated during phase 1, of which 12 corresponded to gram-negative bacilli. With regard to resistance profiles, 13 showed multidrug resistant and extensively drug resistant profiles. During phase 2, no cases of SSI were recorded (relative risk = 0.158 [95% confidence interval 0.0873-0.255], P = .0352].

CONCLUSION:

A multimodal approach allowed for the reduction of the incidence of SSI in LTs and offered a protective strategy.

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