Surgical Infection Society Guidelines on Antibacterial and Antifungal Prophylaxis in Liver Transplantation

Authors:
Simeng Wang, Samy-Malik Bendjemil, Hugo Bonatti, William Chiu, Jared Huston, Amanda Jensen, Deepak Ozhathil, Joseph Forrester

Body of Abstract:
Background

Liver transplantation is a life-saving procedure for patients with end-stage liver disease. Risk of post-transplantation infection remains high despite improvement in graft and patient survival. Antibacterial and antifungal prophylaxis play an important role in reducing infection-related morbidity and mortality, but the optimal timing and regimen are not well defined.

Methods

The Surgical Infection Society’s Therapeutics and Guidelines Committee and individuals with content expertise convened to develop guidelines on antibacterial and antifungal prophylaxis in liver transplant to prevent surgical site infection and other infections, shorten intensive care unit length of stay, and decrease mortality. PubMed, Embase, Web of Science, and the Cochrane Database were searched using medical subject heading (MeSH) terms including “liver transplantation”, “antibiotic prophylaxis”, and “antifungal prophylaxis” for studies limited to randomized controlled trials, systematic reviews, meta-analyses, cohort, and case-control studies in adult patients. Evaluation of the published evidence was performed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system and final recommendations were developed by an iterative process.

Results

We cannot make a recommendation for or against using preoperative (more than one hour prior to incision) antibiotic prophylaxis in liver transplantation with available evidence. We suggest use of broad-spectrum antibiotic prophylaxis in liver transplantation rather than gram-positive antibiotic prophylaxis alone (Grade 2B). We recommend limiting administration of antibiotic prophylaxis at 24 hours postoperatively after liver transplant (Grade 1B). We recommend against empirical antifungal prophylaxis for patients at low risk for invasive fungal infections after liver transplant; for patients at high risk for invasive fungal infection, antifungal prophylaxis should be considered (Grade 1B).

Conclusions

This guideline summarizes the current Surgical Infection Society recommendations on antibacterial and antifungal prophylaxis in liver transplantation.