BLOOD CULTURE VALUE IN PATIENTSWITH SEVERE INFECTIONS AFTER LIVER TRANSPLANTATION
Abstract:
Introduction: Even if the evolution of liver transplantation, as a life-saving surgical
procedure, registered lately a major progress in surgical techniques and immunosuppressive therapy,
the risk of sepsis still remains a global concern. Objective: Promptly recognizing and testing the
bacterial strains, isolated from blood cultures in liver transplanted patients, who presented with sepsis,
with or without an apparent origin. Methods: From 2010 until 2012, a retrospective bacteriological
study was performed on a group of 195 liver transplanted patients at “Dan Setlacec” General Surgery
and Liver Transplantation Centre Fundeni. Aiming at cultivation and qualitative recovery, the positive
and negative blood cultures were screened with BACTEC 9050 system (Becton Dickinson). We collected
from all pre-transplanted patients, two or three sets of aerobic and anaerobic blood cultures (control).
We also collected blood cultures from those who had signs of after-transplantation infection such as
bacteremia, severe sepsis, septic shock. Smears and cultures on culture media were performed from
positive blood cultures. In order to establish the minimum inhibitory concentration, antimicrobial
susceptibility testing was done by disc diffusion and automatic methods. Results: After-transplantation
infections are complications with a very high mortality rate. In order to decrease them, it is important to
make a bacteriological diagnosis to establish the etiology. To do that, one should perform blood cultures
and antimicrobial susceptibility testing. These have major contributions, not only in identifying the
cause, but also in choosing the adequate therapy. In our study, 47.3% was Gram-negative bacterial
infections, 7.5% was Candida albicans fungal and shown spp. infections and 17.04% were noncompliant
samples, reported as contaminated. There have been cases of sepsis without bacterial
growing, reported as negative after 7 days of incubation. Conclusions: In order to maintain a lower rate
of multidrug-resistant strains and to have an effective treatment, the selection of an antibiotic must be
correlated to the etiological profile of the germ.
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