Evaluation of the guidelines for infection control and prevention, which was made for national university hospitals in Japan

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The incidence of infection after liver transplantation (LT) is generally high because of the technical complexity and potentially contaminated environment within the abdominal cavity. Our main aim in this study was to investigate if the infection rate in LT could be reduced when probiotics and immunonutrition were supplemented. And we evaluated the influence of change of prophylactic antimicrobials (ABPC and CTX) to bacteremia after LT, and investigated risk factors for the severe and representative opportunistic post-LT infection by invasive aspergillosis (IA) and cytomegalovirus (CMV). Because of the difficulty of probiotics and immunonutrition intake according to study protocol, enrollment were insufficient for analysis. However, the safety of these drugs for LT recipients could be demonstrated, therefore, we are planning the additional study by the modified protocol. The incidence of bacteremia decreased significantly from 26.3 per 100 LDLT in PRE period (2000-02) to 18.4 in POST period (03-06). Bacteremia caused by both ABPC and CTX- resistant species decreased (from 15.1 to 10.1) more than those by susceptible species (from 11.2 to 8.4), with remarkable reduction of bacteremia caused by MRSA (from 5.0 to 2.5) and enterococci (from 7.7 to 4.5). Risk factors for IA were preoperative intensive care unit stay and preoperative steroid administration. Preoperative steroid administration for fulminant hepatitis (FH) possibly predisposed to the development of IA after LT. Also, multivariate analysis revealed FH as an underlying disease, ABO-incompatible LT, and a serological combination of the donor positive/recipient negative for CMV (D+/R-) were independently associated with the development of CMV infection. The data obtained by this study revealed the evidence for the management of LT recipients to prevent severe bacterial infection, IA, and CMV infection.