Multi-Drug-resistant Organism (MDRO) Infections in Liver Transplant Recipients 30 Days Post-Transplant

BACKGROUND: The leading cause of morbidity and mortality in liver transplant recipients (LTR) is bacterial infection, with the highest rates seen in the first 30 days after transplantation. LTR may be at increased risk for MDROs due to their complicated pre- and post- transplantation course. METHODS: We performed a retrospective chart review of the clinical characteristics of LTR to determine risk factors for the development of MDROs post transplantation. A secondary analysis was performed to determine the role of Rifaximin in the development of MDRO infections given its known antimicrobial properties. All adult, first time LTR (January 2012 to December 2016) were included in this study. We determined relative risk for specific clinical characteristics by performing a univariate analysis. RESULTS: Of the 329 adult LTR, 92 (27.9%) developed a bacterial infection and 36 (11%) developed MDRO infections in the immediate post-operative period; MDROs accounted for 39.1% (36/92) of all infections. The majority of MDRO infections were due to gram-negative rods (62%). However, the most common isolates were: Vancomycin-Resistant Enterococci (23.8%) and Klebsiella pneumoniae(19%). The most common sites of infection were: respiratory tract (32%), urine (23%), and intraabdominal (20%). The following pre transplant risk factors for the development of an MDRO infection included: prior antibiotic treatment and ICU admission (P < 0.05). However, spontaneous bacterial peritonitis (SBP) prophylaxis alone was not associated with an increased risk for an MDRO infection. Post transplant risk factors for the development of an MDRO infection included: prolonged ICU stay, return to the OR, renal replacement therapy, and mechanical ventilation (P < 0.05). Rifaximin use was associated with a relative risk of 2.2 (P = 0.0198) for the development of an MDRO infection. In patients who had received Rifaximin, the MELD score of those who developed MDRO infections was higher at 28 vs. those who did not develop an MDRO infection at 23 (P = 0.017). CONCLUSION: Nearly 40% of LTR who develop post-operative infections are due to MDROs with antibiotic exposure and post-transplant critical care complications as contributing factors. Pre-transplant Rifaximin use may be associated with the development of MDRO infections in LTR. DISCLOSURES: All authors: No reported disclosures.