No Increased Risk of Infection Following a Protocol Change to Decrease Duration of Perioperative Antibiotic Prophylaxis in Liver Transplantation

BACKGROUND: Liver transplant recipients are at high risk of bacterial surgical site infection (SSI) following transplantation. However, they also have increased risks of antibiotic complications such as C. difficile and resistant organism infections. The optimal duration of perioperative antibiotic prophylaxis for liver transplantation is uncertain. METHODS: We analyzed infection outcomes in a total of 192 patients before and after a protocol change that shortened antibiotic prophylaxis duration at our institution. Durations were risk-stratified with longer durations for patients hospitalized prior to liver transplantation. The recommended duration of antibiotic prophylaxis changed from 5 days or until transfer out of intensive care to 3 days for patients hospitalized prior to transplant and from 2 days to 1 day for all other patients. RESULTS: There was no increased rate of SSI or bacteremia following the decrease in duration, with a change from 2.4% to 2.8% in patients hospitalized prior to transplant and 7.5% to 2.9% in other patients. Risk of SSI or bacteremia was not significantly increased in a multivariable model (OR 0.50, 95% CI 0.07-2.24; p = 0.41). There was no significant difference in readmission, graft rejection, graft failure, or mortality. Rates of acute kidney injury, C. difficile infection, and development of resistant organisms were not significantly different. CONCLUSION: Shortening the duration of perioperative antibiotic prophylaxis in liver transplantation does not increase the risk of infection and may reduce harms of antibiotic exposure.