Implementation and impact of an antibiotic control program and multidrug-resistant bacterial colonization in a liver transplant unit.

INTRODUCTION: infections by multidrug-resistant bacteria are a major cause of morbidity and mortality in transplant patients. OBJECTIVE: a retrospective single-center study was performed to evaluate the implementation of an Antimicrobial Treatment Optimization Program (PROA) on multidrug-resistant bacteria colonization and infection after liver transplant (LT). METHODS: colonization by multidrug-resistant bacteria and infections during the first year after a liver transplant were analyzed in a group of 76 transplanted patients in two stages, before and after PROA (2016-2019). Clinical variables related to infection, readmissions and survival one year after the liver transplant were analyzed. RESULTS: there was good adherence to the PROA. Infection was the most frequent cause for readmission during the first year after the liver transplant. Incidence of infections was similar during both periods (mean of 1.25 and 1.5 episodes of bacterial infection per patient/year, respectively) with 19 bacterial infectious episodes, six by hospital-acquired multidrug-resistant and extensively drug-resistant (MDR-XDR) bacteria in the pre-PROA stage, and 18 bacterial infectious episodes, five by MDR-XDR in the post-PROA stage. A 37 % decrease of post-TH of rectal colonization by MDR-XDR after liver transplant was observed during 2019. CONCLUSIONS: epidemiological surveillance policies and antibiotic optimization are key to control the increase of colonization and infection by multidrug-resistant bacteria in liver transplant units. Long-term studies are needed to better evaluate the impact of these programs.

Complicated giant colonic diverticulum: imaging-based diagnosis.

A 66-year-old male from Venezuela with history of high blood pressure and diverticulosis is being studied on an outpatient basis for abdominal pain and weight loss of several months of evolution. He presented to the emergency department due to worsening abdominal pain in the last 48 hours and fever. His abdomen was mildly tender to palpation in the left hypochondrium but did not exhibit signs of peritonitis. An abdominal x-ray was performed, revealing an oval, smooth-walled mass located in the left upper quadrant that contained a gas-fluid level. An outpatient abdominal CT scan performed two months earlier showed an intraabdominal, 14.8x10x16cm air cystic lesion, proposing giant colonic diverticulum as first diagnostic possibility. Given the findings of the abdominal x-ray, urgent abdominal CT was requested (image 3) with results suggestive of sigmoid-dependent giant diverticulum, complicated by probable superinfection and torsion of the sigma at its base. Considering the suspected diagnosis, the patient underwent diverticulectomy, demonstrating purulent content inside. Histopathology confirmed the diagnosis. Evolution after surgery was favourable and the patient was discharged on the sixth postoperative day.