Bacterial infections post-living-donor liver transplantation in Egyptian hepatitis C virus-cirrhotic patients: A single-center study

Table 1 Comparison between patients who developed post-living-donor liver transplantation single episode and those who developed repeated episodes of infection regarding pre-operative parameters n (%)

	Single episode of infection (n = 21)	Repeated episodes of infection (n = 12)	P value
Recipient's age (yr, mean ± SD)	51.2 ± 8.3	52.08 ± 8.7	0.767
Donor's age (yr, mean ± SD)	26.9 ± 6.3	32.3 ± 6.1	0.021
Recipient's gender (male/female)	19/2	12/0	0.523
Donor’s gender (male/female)	19/2	10/2	0.610
Hepatocellular carcinoma	6 (28.6)	8 (66.7)	0.033
History of bridging procedures1	4 (19.0)	6 (50.0)	0.114
History of SBP	10 (47.6)	1 (8.3)	0.052
History of paracentesis	11 (52.4)	4 (33.3)	0.290
Diabetes mellitus	8 (38.1)	5 (41.7)	1.000
Child-Pugh class (B/C)	10/11	5/7	0.741
MELD score (median, interquartile range)	14 (12-16)	16 (15-18)	0.136
Thrombocytopenia2	20 (95.2)	12 (100.0)	1.000
Leucopenia3	9 (42.9)	5 (41.7)	0.947
Renal impairment	2 (9.5)	1 (8.3)	1.000
High serum ferritin4	13 (61.9)	5 (41.7)	0.261
High C-reactive protein5	14 (66.7)	11 (91.7)	0.206

¹Bridging procedures included: Radiofrequency ablation, trans-arterial chemo-embolization and micro-wave ablation;

²Thrombocytopenia: Platelets less than 150000/mm³;

³Leucopenia: WBCs less than 4000/mm³;

⁴High serum ferritin: More than 333 ng;

⁵High C-reactive protein: More than 0.5 mg/L. SBP: Spontaneous bacterial peritonitis.

Table 2 Comparison between patients who developed single episode and those who developed repeated episodes of infection regarding operative details

	Single episode of infection (n = 21)	Repeated episodes of infection (n = 12)	P value
CIT (min), mean ± SD	43.6 ± 17.3	50.8 ± 17.7	0.259
WIT (min), mean ± SD	45.7 ± 13.4	50.8 ± 12.4	0.288
Recipient's operative time (h), mean ± SD	10.3 ± 1.1	10.5 ± 1.5	0.704
Packed red cell transfusion (U), (median, interquartile range)	2 (2-4)	3 (2-6)	0.493

CIT: Cold ischemia time; WIT: Warm ischemia time.

Table 3 Length of intensive care unit stay, length of exposure to invasive procedures, and time to occurrence of infection in patients who suffered from single vs repeated episodes of infection

	Single episode of infection (n = 21)	Repeated episodes of infection (n = 12)	P value
Length of ICU stay (d)	6 (5-7)	7 (5-7)	0.969
Days on mechanical ventilator	1 (1-1)	1 (1-1)	0.176
Days with CVC	6 (5-7)	6 (5-7)	0.770
Days with urinary catheter	6 (5-7)	7 (6-8)	0.467
Days with drains	17 (15-20)	25 (21-30)	0.002
Time-to-infection (d)	14 (12-17)	9 (6-19)	0.189

Data are presented as median (interquartile range). ICU: Intensive care unit; CVC: Central venous catheter.

Table 4 Site of infection and implicated organisms in patients who suffered from single vs repeated episodes of infection n (%)

	Single episode (n = 21)	Repeated episodes (n = 36)1	P value
Site of organism isolation			0.896
Bile	6 (28.6)	10 (27.8)
Wound	1 (4.8)	2 (5.6)
Sputum	3 (14.3)	7 (19.4)
Drains	5 (23.8)	7 (19.4)
Blood	3 (14.3)	8 (22.2)
Urine	2 (9.5)	2 (5.6)
Ascitic fluid	1 (4.8)	0 (0.0)
Oragnism isolated			0.456
Goagulase (-) Staph. aureus	3 (14.3)	1 (2.8)
Staph. aureus	0 (0.0)	1 (2.8)
MRSA	3 (14.3)	1 (2.8)
E. coli	2 (9.5)	4 (11.1)
Klebsiella species	2 (9.5)	3 (8.3)
Pseudomonas aeruginosa	4 (19.0)	3 (8.3)
Acinetobacter baumannii	4 (19.0)	12 (33.3)
Proteus	0 (0.0)	2 (5.6)
Enterobacteriaceae	1 (4.8)	1 (2.8)
Enterococci	1 (4.8)	2 (5.6)
Bacillus species	0 (0.0)	2 (5.6)
Pseudomonas + Acinetobacter	1 (4.8)	0 (0.0)
Pseudomonas + Klebsiella	0 (0.0)	2 (5.6)
Acinetobacter + Klebsiella	0 (0.0)	1 (2.8)
Acinetobacter + coagulase (-) Staph. aureus	0 (0.0)	1 (2.8)

¹Represents the total number of attacks occurred among the 12 patients who developed repeated episodes of infections. MRSA: Methicillin-resistant Staphylococcus aureus.

Table 5 Antimicrobial sensitivity in patients who suffered from single vs repeated episodes of infection n (%)

Antimicrobial		All episodes of infection (n = 57)	Single episode of infection (n = 21)	Repeated pisodes of infection (n = 36)	P value
Levofloxacin	S	11 (52.4)	2 (22.2)	9 (75.0)	0.030
	R	10 (47.6)	7 (77.8)	3 (25.0)
Ciprofloxacin	S	5 (38.5)	0 (0.0)	5 (45.5)	0.487
	R	8 (61.5)	2 (100.0)	6 (54.5)
Co-trimoxazole	S	1 (7.1)	0 (0.0)	1 (10.0)	1.000
	R	13 (92.9)	4 (100.0)	9 (90.0)
Penicillin	S	1 (11.1)	1 (14.3)	0 (0.0)	1.000
	R	8 (88.9)	6 (85.7)	2 (100.0)
Doxycycline	S	14 (77.8)	5 (100.0)	9 (69.2)	0.278
	R	4 (22.2)	0 (0.0)	4 (30.8)
Vancomycin	S	8 (88.9)	4 (100.0)	4 (80.0)	1.000
	R	1 (11.1)	0 (0.0)	1 (20.0)
Piperacillin-tazobactam	S	8 (72.7)	3 (75.0)	5 (71.4)	1.000
	R	3 (27.3)	1 (25.0)	2 (28.6)
Aminoglycosides	S	9 (75.0)	1 (50.0)	8 (80.0)	0.455
	R	3 (25.0)	1 (50.0)	2 (20.0)
Imipenem	S	20 (69.0)	8 (88.9)	12 (60.0)	0.201
	R	9 (31.0)	1 (11.1)	8 (40.0)
Ceftrioxone	S	7 (38.9)	1 (16.7)	6 (50.0)	0.316
	R	11 (61.1)	5 (83.3)	6 (50.0)
Cefotaxime	R	8 (100.0)	7 (100.0)	1 (100.0)	-
Aztreonam	R	6 (100.0)	1 (100.0)	5 (100.0)	-

S: Sensitive; R: Resistant.

Table 6 Multivariate binary logistic regression model for prediction of the occurrence of repeated episodes of infection

	Regression coefficient	SE	Odds ratio	95%CI	P value
Donor’s age (yr)	0.05	0.08	1.05	0.90-1.23	0.552
Hepatocellular carcinoma (HCC = 1, no HCC = 0)	3.24	1.43	25.44	1.53-422.21	0.024
Duration of drain insertion (d)	0.32	0.14	1.38	1.04-1.83	0.024
Constant	-10.28
Model diagnostics
-2 Log Likelihood test	P value, < 0.001
Hosmer and Lemeshow test	P value, 0.369
Correct classification rate	87.88%
ROC curve analysis
AUC	0.935 (95%CI: 0.791-0.991; P value < 0.0001)
Sensitivity, %	91.7 (95%CI: 61.5-99.8)
Specificity, %	81.0 (95%CI: 58.1-94.6)
PPV, %	73.3 (95%CI: 43.8-92.7)
NPV, %	94.4 (95%CI: 72.7-99.9)

HCC: Hepatocellular carcinoma; AUC: Area under ROC curve; ROC: Receiver-operating characteristic; PPV: Positive predictive value; NPV: Negative predictive value.

Table 7 Results of the Kaplan-Meier analysis for time to infection in patients who suffered from single and repeated infection episodes

	Single infection episode (n = 21)	Repeated infection episodes (n = 12)
Median time to infection (d)	14 (95%CI: 13-16)	8.5 (95%CI: 6-17)
Hazard ratio	1.16 (95%CI: 56-2.40)
Log-rank test	P value = 0.647