Selective intestinal decontamination for the prevention of early bacterial infections after liver transplantation

Abstract

Bacterial infection in the first month after liver transplantation is a frequent complication that poses a serious risk for liver transplant recipients as contributes substantially to increased length of hospitalization and hospital costs being a leading cause of death in this period. Most of these infections are caused by gram-negative bacilli, although gram-positive infections, especially Enterococcus sp. constitute an emerging infectious problem. This high rate of early postoperative infections after liver transplant has generated interest in exploring various prophylactic approaches to surmount this problem. One of these approaches is selective intestinal decontamination (SID). SID is a prophylactic strategy that consists of the administration of antimicrobials with limited anaerobicidal activity in order to reduce the burden of aerobic gram-negative bacteria and/or yeast in the intestinal tract and so prevent infections caused by these organisms. The majority of studies carried out to date have found SID to be effective in the reduction of gram-negative infection, but the effect on overall infection is limited due to a higher number of infection episodes by pathogenic enterococci and coagulase-negative staphylococci. However, difficulties in general extrapolation of the favorable results obtained in specific studies together with the potential risk of selection of multirresistant microorganisms has conditioned controversy about the routinely application of these strategies in liver transplant recipients.

Keywords: Selective intestinal decontamination, Liver transplant, Infection, Gram-negative bacterial infection, Gram-positive bacterial infection, Multirresistant

Core tip: Liver transplantation has become the treatment of choice for many liver diseases. It is currently a routine procedure but is still associated with significant morbidity being infectious complications the leading cause of death. Selective intestinal decontamination (SID) is a prophylactic strategy that consists of the administration of non-absorbable or systemic antibiotics with scarce anaerobicidal activity in order to prevent or minimize the impact of endogenous infections by potentially pathogenic microorganisms. In this review, we focus on the knowledge regarding the current role of SID in liver transplant recipients. Multiple studies have evaluated the role of SID in the critically ill patient, and several observational studies, randomized clinical trials and a meta-analysis have focused in liver transplantation. Our aim is to consolidate the current literature to better outline the impact of SID in the prevention of infections in this setting.