Risk Factors for Methicillin-Resistant Staphylococcus Aureus Infection in Liver Transplant Recipients

Background/Aims: Staphylococcus aureus is the leading cause of bacterial infection in liver transplant recipients. Preoperative nasal carriage of methicillin-resistant S. aureus (MRSA) is associated with a high risk of infection. The aim of this work is to study the characteristics, clinical impact and to determine independent risk factors for early S. aureus infection in recipient patients with nasal carriage after LDLT. Methods: This is a retrospective cohort hospital based study reviewed the data from 50 consecutive patients who underwent living donor liver transplantation (LDLT). Patients’ were screened preoperatively for methicillin-susceptible S. aureus (MSSA) and MRSA nasal carriage. Risk factor analysis was performed by univariate and multivariate analysis followed by stepwise logistic regression. Results: Of the 50 patients included, 11 (22.0%) patients developed S. aureus infection (10 MRSA, 1 –ve for both MRSA and MSSA) within 1 month of surgery. The most common sites of MRSA infection were urogenital infection 4 (3 1 %), followed by abdominal infection and wound infection 3 (23%) for each. MRSA nasal carriage, careless healthcare workers not wearing personal protective equipments, excessive prior antibiotic usage, length of post transplantation ICU stay (days) and prothombin ratio % are highly significant as a risk factor for the development of MRSA infection, while previous history of ascites, other major post transplantation infections episodes/patient are only significant as a risk factor for MRSA infection. Mortality in patients who developed MRSA infections was (63.6%). Conclusion: There is a high incidence of MRSA early after LDLT in adults. Surveillance culture should be checked periodically before and after admission to determine which patients are at high risk for MRSA infection and to administer appropriate antimicrobials for perioperative infection. Mandatory wearing of gowns and gloves by everyone who enters the room of a patient colonized or infected with MRSA; staff cohorting for MRSA positive and MRSA-negative patients in the ICU; monitoring and strict reinforcement of compliance with the infection control measures.