Table 4.
- Management of infectious complications in liver transplantation (LT) listed patients.
| Infectious Complication | Evidence | Recommendations |
|---|---|---|
| UTI | • Almost 90% of nosocomial UTIs are mainly Foley catheter-related and can precipitate to AKI | • Insertion of Foley catheters in patients should only be used when absolutely indicated |
| SBP | • SBP is a common precipitant of AKI and encephalopathy and often complicates gastrointestinal hemorrhage. | • All hospitalized patients with cirrhosis and ascites should undergo diagnostic paracentesis to rule out SBP at admission or if clinical deterioration occurs. |
| • Nosocomial SBP is more often MDR, more frequently caused by gram-positive organisms, and has up to 50% mortality. | • Primary prophylaxis in patients: with ascitic fluid total protein, <1.5 g/dL; CTP score 9 and serum bilirubin, 3 mg/dL or renal impairment (sCr, 1.2 mg/dL; serum blood urea nitrogen, 25; or serum Na, 130) | |
| • Secondary SBP prophylaxis is always indicated. | ||
| • The drug of choice for the prophylaxis is norfloxacin or, if not available, daily ciprofloxacin or trimethoprim/sulfamethoxazole would be the preferred substitution. | ||
| • Piperacillin/tazobactam or meropenem is recommended during SBP infection, and patients should receive intravenous albumin to prevent HRS | ||
| Clostridium difficile colitis | • Incidence and severity is increasing in hospitalized patients, directly related to liver disease as well as other modifiable risk factors namely, SBP antibiotic prophylaxis, other antibiotic use, and PPI use | • Low-risk patients can safely receive metronidazole, but patients with severe diseases require the use of either oral vancomycin or fidaxomicin |
| Pneumonia | • Usually precipitated by multiple risk factors: | • Pneumonia must always be distinguished from volume overload and atelectasis |
| • Hepatic encephalopathy and gastrointestinal bleeding both increase the risk of aspiration | ||
| • Use of PPIs increases gastrointestinal flora growth | ||
| • Ascites increase intra-abdominal pressure that can result in atelectasis |
UTI: urinary tract infection, AKI: acute kidney injury, SBP: spontaneous bacterial peritonitis, MDR: multi drug-resistant, PPI: proton pump inhibitor, CTP: Child-Turcotte-Pugh, sCR: serum creatinine, HRS: hepatorenal syndrome