Standardization of post‐operative antimicrobials reduced exposure while maintaining good outcomes in pediatric liver transplant recipients

Infections following orthotopic liver transplant (OLT) result in significant morbidity and mortality, warranting careful consideration of risks associated with antibiotic overuse and benefits of infection prevention. In the absence of specific guidelines for antimicrobial prophylaxis in pediatric OL...

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Bibliographic Details
Published in:Transplant infectious disease 2021-06, Vol.23 (3), p.e13538-n/a
Main Authors: Bio, Laura L., Schwenk, Hayden T., Chen, Sharon F., Conlon, Sarah, Gallo, Amy, Bonham, Clark Andy, Gans, Hayley A.
Format: Article
Language:English
Subjects:
Antibiotics
Antiinfectives and antibacterials
Antimicrobial agents
Caspofungin
Disease prevention
Exposure
Fever
Infections
Liver
Liver transplantation
Liver transplants
Morbidity
Pediatrics
perioperative
Prophylaxis
Standardization
Statistical analysis
Transfusion
transplantation
Vancomycin
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Summary:Infections following orthotopic liver transplant (OLT) result in significant morbidity and mortality, warranting careful consideration of risks associated with antibiotic overuse and benefits of infection prevention. In the absence of specific guidelines for antimicrobial prophylaxis in pediatric OLT, we developed a standardized approach to post‐operative (post‐op) antimicrobial therapy including 48 hours of antibiotics, no vancomycin for post‐op fever within the first 48 hours, and caspofungin only for certain situations. The goal was to reduce antimicrobial utilization and adverse outcomes associated with longer duration of and broader treatment while maintaining good outcomes. The impact of this standardization on antimicrobial utilization and clinical outcomes at the largest pediatric liver transplant center in the United States is described. All individuals receiving an OLT from 1/1/17‐9/30/17 (N = 38) and 3/14/18‐12/13/18 (N = 27) were included in the pre‐intervention (PreI) and post‐intervention (PostI) groups, respectively. The intervention resulted in a significant reduction in individuals receiving post‐op broad‐spectrum gram‐negative antibiotics for >48 hours (76% PreI vs 44% PostI OLT recipients, P = .01) and post‐op vancomycin use (50% PreI, vs 7.4% PostI, P 
ISSN:1398-2273
1399-3062
DOI:10.1111/tid.13538