• Constantine J Karvellas, Mark McPhail, Fred Pink, Sonal Asthana, Paolo Muiesan, Nigel Heaton, Georg Auzinger, William Bernal, Ian Eltringham, and Julia A Wendon.
• Divisions of Gastroenterology (Liver Unit) and Critical Care Medicine, University of Alberta, Edmonton, Canada. cjk2@ualberta.ca
• J Crit Care. 2011 Oct 1;26(5):468-74.

PurposeThis study aims to investigate what factors predict the development of postoperative bloodstream infection (BSI) in patients transplanted electively for chronic liver disease and compare outcomes in infected transplant recipients (BCLD) with noninfected patients (CLD).MethodsA retrospective cohort study of 218 patients who had elective liver transplantation (LT) between January 2003 and July 2005 and admitted to a specialist intensive care unit (ICU) was done.ResultsFifteen patients had BSI post-LT (BCLD, 29 isolates) while in the ICU, and 203 patients did not (CLD). Thirty-eight percent of isolates were gram negatives; 55%, gram positives; and 7%, fungemia. Median time to first BSI post-LT was 11 days (range, 3-16 days). On admission post-LT to the ICU, patients with BCLD had higher Acute Physiology and Chronic Health Evaluation II scores (23 vs 10, P < .001). While in the ICU, patients with BCLD had greater requirements for renal replacement therapy (73% vs 8%) and days on mechanical ventilation (17 vs 2 days) and longer median ICU stay (21 vs 3 days, P < .001 for all). One-year survival was worse in the BCLD group (40% vs 94%, P < .001). On multivariate analysis, Acute Physiology and Chronic Health Evaluation II score (odds ratio, 1.36) post-LT was independently associated with subsequent BSI. Bloodstream infection (hazards ratio, 8.7) was independently associated with mortality.ConclusionBloodstream infection post-LT was associated with increased severity of illness on admission, greater requirements for organ support, and increased mortality.Copyright © 2011 Elsevier Inc. All rights reserved.

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