Association of preoperative culture screening and post liver transplant infection rate

Abstract

Transplantacija jetre u današnje vrijeme je rutinska metoda liječenja kod akutnog i kroničnog ireverzibilnog zatajenja jetre. Iako se ovom metodom ostvaruju zavidni rezultati, ona nije prvi izbor liječenja već se primjenjuje ukoliko se razviju komplikacije jetrene bolesti i kada su sve druge opcije iscrpljene. Razlozi tome su višestruki, od nesrazmjera u potražnji i dostupnosti organa, složenosti ovog invazivnog postupka te daljnjoj primjeni imunosupresivnih lijekova što rezultira potencijalno velikim brojem komplikacija. Infekcije nakon transplantacije jetre smatraju se najčešćim komplikacijama i vodećim uzrokom smrti bolesnika podvrgnutih ovom zahvatu. Obzirom na vremenski odmak od transplantacije različito su uzrokovane, pa su tako one u ranom poslijeoperacijskom periodu uglavnom bakterijske prirode dok su kasnije zastupljeniji uzročnici virusi i mikobakterije. Neposredno iza zahvata infekcije su uglavnom slične drugim kirurškim infekcijama u bolničkom okruženju, a u današnje vrijeme sve veći problem predstavljaju infekcije uzrokovane multiplorezistentnim patogenima (MDR - Multiple drug resistance). Uz primjerenu primjenu imunosupresije, potrebno je strategiju prevencije nastanka infekcija usmjeriti prema učinkovitoj profilaksi, promptnoj identifikaciji uzročnika, racionalnoj primjeni antimikrobnih lijekova kao i provedbi mjera kontrole bolničkih infekcija. Do danas je učinjen velik napredak u prevenciji i liječenju infektivnih komplikacija.Liver transplantation nowadays is a routine treatment method for acute and chronic irreversible liver failure. Although significant results are achieved by this method, it is not the first choice of the treatment but is applied in cases when liver disease complications develop and other options have been exhausted. The reasons for this are multiple, from inbalance between the demands and the avalability of the organs, the complexity of this invasive procedure as well as the further use of immunosuppressive drugs resulting in a potentially large number of complications. Infections following the liver transplants are considered the most common complications and are the leading cause of death of the patients undergoing this procedure. Relating to the time lag between the transplation and the infection, the infections are caused by various factors, so in the early postoperative period they are mainly of bacterial nature, whereas viruses and mycobacteria are more present agents later. Immediately after the operation they are primarily similar to other surgical infections in the hospital environment and today the increasing problem are the infections caused by multidrag resistant pathogens (MDR- multiple drug resistance). With the proper application of immunosuppression, the strategy of infection prevention should be directed towards the effective prophylaxis, prompt identification of pathogens, rational use of antimicrobial drugs and the implementation of the measures of hospital infections control. To date, a great progress has been made in the prevention and the treatment of infection complications