Evaluation of Anti-Pseudomonal Versus Non-Pseudomonal Agents for Peri-Operative Antibiotic Prophylaxis in Patients Undergoing Delayed Biliary Reconstruction After Liver Transplantation

Abstract

Background:

Short durations of anti-pseudomonal (Pa) antibiotic (ABX) therapy may seem low-risk; however, emerging data highlight subsequent multi-drug-resistant pathogens in previously treated patients. This study aims to evaluate the safety and efficacy of Pa versus non-pseudomonal (NPa) ABX prophylaxis in liver transplant (LT) recipients undergoing delayed biliary reconstruction (DBR).

Methods:

This is a single-center, retrospective study of LT recipients following a protocolized change in ABX prophylaxis when undergoing DBR between January 2017 and March 2023. Patients who received piperacillin-tazobactam or cefepime and metronidazole were assigned to the Pa cohort, and those who received ceftriaxone and metronidazole were assigned to the NPa cohort. Surgical site infection (SSI), any bacterial infection, total ABX days, and re-initiation or escalation of ABX therapy were compared between the Pa and NPa cohorts.

Results:

Forty-eight patients were included in the study, with 27 in the Pa cohort and 21 in the NPa cohort. SSI at 30 days occurred in 10 (37.0%) compared with 4 (19.0%) patients in the Pa and NPa cohorts (p = 0.174), respectively. There were no differences in any bacterial infection, total ABX days, or re-initiation or escalation of ABX therapy. Thirty-day culture results yielded eight (72.7%) Enterococcus faecium species (seven in the Pa cohort) and no Pseudomonas aeruginosa.

Conclusions:

NPa ABX for peri-operative prophylaxis for patients who undergo DBR in LT was not associated with an increased infectious risk compared with broader-spectrum agents. The combined clinical and microbiological outcomes question the routine need for Pa therapy in this setting.