European multicenter survey on antibiotic prophylaxis in liver transplant patients

Introduction

Infection remains a major problem for patients undergoing liver transplantation (LT). However, no data regarding perioperative antibiotic prophylaxis are available. The aim of the study was to gain insight into prophylactic antibiotic strategies used in European liver transplant centers.

Methods

An electronic and postal survey was sent to all LT centers, members of the European Liver and Intestine Transplantation Association. The questionnaire asked for the prophylactic antibiotic regimen used for LT recipients undergoing elective LT, for LT recipients with acute-on-chronic liver disease, and for LT recipients with acute liver failure, respectively.

Results

A total of 59 centers (46% response rate) from 16 different countries completed the questionnaire. Of all participating centers, 8.6% reported to perform <25, 37.9% reported 25–50, 27.6% reported 50–75, 10.4% reported 75–100, and 15.5% reported >100 LTs annually. Antibiotic prophylaxis for recipients with elective LT consisted of one single antibiotic in 48.3%. In 50%, combination therapy was given; whereas in 1.7%, the prophylactic regimen rotated from monotherapy to combination therapy on a 6-month basis. The mean duration of prophylaxis was 3.1 ± 2.0 days. In 19% of the centers prophylaxis was restricted to 1 day only, to the first 2–3 days in 55.2%, and for more than 3 days in 24.1% (one missing answer). Monotherapy consisted of a first-line antibiotic agent (first-generation and second-generation cephalosporin, or aminopenicillin) in 42.9%, and of a broad-spectrum antibiotic (third-generation cephalosporin, piperacillin, or carbapenem) in 57.1% of centers. For recipients with acute-on-chronic disease, 73.7% used the same antibiotic regimen as used for elective LT, while 26.3% changed it (5.3% increased the duration of prophylaxis, and 21.0% changed the type of antibiotic). For recipients with acute liver failure, 66.7% used the same antibiotic regimen as used for elective LT, while 33.3% changed it (10.5% changed the duration of prophylaxis, and 22.8% changed the type of antibiotic).

Conclusion

Among European LT centers, considerable variation exists in the antibiotic prophylactic strategies used for liver transplant recipients, both in terms of antibiotic regimen used and in duration of therapy. These findings underscore the need for the development of specific guidelines.