Surgical site infections after liver transplantation: Emergence of multi-drug resistant bacteria and implications for prophylaxis and treatment strategies.

Background: Perioperative antimicrobial prophylaxis is administered to liver transplant (LTx) recipients to prevent surgical site infections (SSIs), but regimens are not standardized and there are limited effectiveness data. Prevention and treatment of SSIs have been complicated by the emergence of multi-drug resistant (MDR)-pathogens. Methods: We retrospectively reviewed SSIs among 331 LTx recipients at our center in 2010-2014. Results: Culture-proven superficial and deep SSIs occurred in 3% and 15% of patients, respectively, at median 12.5 and 13.5 days post-LTx. Recipients with superficial SSIs and those without SSIs were similar in demographics, clinical characteristics, length of hospital stay, and mortality. Deep SSIs included abscesses (58%), peritonitis (28%), deep incisional infections (8%), and cholangitis (6%). Rates of deep SSIs were comparable among patients receiving prophylaxis with ampicillin-sulbactam, aztreonam and vancomycin, or tigecycline (p=0.61). Independent risk factors for deep SSIs were bile leak (p

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