Quality of Surgical Care in Liver and Small-Bowel Transplant: Approach to Risk Assessment and Antibiotic Prophylaxis

transplantation has been growing, as has the demand for stricter and more innovative approaches to prevent and control health care–acquired infections.1-3 Surgical site infections (SSIs) remain a major problem in liver and small-bowel transplant recipients and are associated with a significant increase in resource utilization. Patients in whom SSIs develop have significantly higher 1-year graft failure, longer hospital stay, an excess in charges, and higher mortality than do patients in whom infections do not develop.4,5 Researchers in 1 study4 estimated that each SSI in a liver transplant patient resulted in an excess hospital stay of 24 days and roughly $130 000 in excess charges. SSIs account for approximately 15% of all hospital-related infections in transplant patients and are one of the most common bacterial infections after liver transplant, with rates ranging from 9% to nearly 40%.6-8 Our transplant center’s epidemiological data revealed that among all hospital-acquired infections in transplant patients, SSIs accounted for 48% (n=119) of all infections, followed by bloodstream infections at 24% (n = 49), and infections associated with urethral catheters at 15% (n = 31) for the period from January 1, 2006, through December 31, 2008 (Figure 1). Because of their high incidence, SSIs were targeted for further evaluation. No evidence-based guidelines regarding how to prevent SSIs in small-bowel and liver transplant recipients are currently available. Transplant centers do not participate in the National Surgical Quality Improvement Program, which is administered by the American College of Surgeons, nor do they participate in the National Surgical Care Improvement Program, administered by the Centers for Medicare and Medicaid Services and the Centers for Disease Control and Prevention (CDC). No governmental agency or medical society has provided guidelines about appropriate surgical prophylaxis in transplant patients. Because of the lack of guidelines, efforts should be directed toward the (1) prevention of bacterial infections in patients Quality of surgical care in liver and small-bowel transplant: approach to risk assessment and antibiotic prophylaxis