Prevention

Adequate surgical technique is one of the most important factors that prevent infectious complications. Because of the high morbidity and mortality of gram-negative infections, the eradication of oral and gut flora may be desirable. This is accomplished with the use of oral selective bowel decontamination (OSBD), consisting of nonabsorbable antibiotics that eliminate gram-negative aerobic bacteria and fungi. These regimens spare gram-positive and anaerobic organisms that have an antagonistic effect on the growth of gram-negative pathogens. OSBD is most effective when initiated one week prior to transplant surgery and continued post-operatively for one to three weeks. Whereas the overall incidence of infection with OSBD is not different than without it, there is a substantial decrease in the incidence of gram-negative bacteremias, which carry a high mortality as mentioned above. After OSBD, most infections in patients are secondary to gram-positive organisms. Some centers have noted the emergence of infections caused by resistant gram-positive organisms such as VRE; however, the exact relationship to OSBD is unclear.

Peri-operative prophylaxis with an extended-spectrum cephalosporin is routinely administered to prevent surgical wound infections. In general, antibiotics are continued for 24 to 48 hours post-operatively. It is recommended that liver recipients also receive antimicrobial prophylaxis prior to post-transplant cholangiograms, liver biopsies, and any other manipulations of the biliary tract.

Renal Transplantation

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