Multidrug resistant bacterial infection in liver transplant recipients: A Deterrent and obstacle

Abstract

Objectives: To determine the microbiological spectrum of multi-drug resistant (MDR) bacterial infections within the first 30 days post-living donor liver transplantation (LDLT) and identify the associated risk factors contributing to their emergence.

Methodology: This retrospective cohort study reviewed the medical records of patients who underwent LDLT from January 2020 to December 2024 at the Liver Transplant and Hepatopancreatobiliary Surgery Unit of Dow University Hospital, Karachi. Patients were categorized into MDR and no-MDR groups based on culture-confirmed MDR bacterial infection with clinical features of sepsis. Types of MDR bacterial infections were noted. Baseline, pre-transplant, intraoperative, and post-transplant variables were recorded. Pearson Chi-square test, Mann-Whitney U test, and univariate and multivariate logistic regression analyses were performed for statistical inference.

Results: Of 151 LDLT recipients, 75 (49.7%) developed MDR bacterial infections within 30 days. Among these, gram negative MDR organisms were predominated, with carbapenem-resistant Enterobacteriaceae (21.2%) and carbapenem-resistant Acinetobacter baumannii (20.5%) most frequent, followed by vancomycin-resistant Enterococci (13.2%). On univariate analysis, MDR infection was associated with pre-transplant ICU admission, renal dysfunction, prolonged postoperative ICU stay, mechanical ventilation >48 h, hemodialysis and/or sustained low-efficiency dialysis (SLED), postoperative complications, longer invasive device duration, prolonged hospital stay, central line-associated blood stream infection (CLABSI), and intra-abdominal infections. On multivariate analysis, only CLABSI [Wald χ²=17.696 (OR 0.021; 95% CI: 0.003–0.127; p<0.001)] and intra-abdominal infections [Wald χ²=25.567 (OR 0.008; 95% CI: 0.001–0.050; p<0.001)] remained independently associated with MDR infection.

Conclusion: Nearly half of LDLT recipients developed MDR infections, predominantly due to gram-negative organisms. CLABSI and intra-abdominal infections emerged as the key predictors of MDR bacterial infections.