1304. Microbial Etiology of Bilomas in Orthotopic Liver Transplant Patients
Session: Poster Abstract Session: Below the Diaphragm
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Schade Biloma IDWeek Poster 2013.pdf (399.4 kB)
  • Background:

    Infected hepatic fluid collections, known as bilomas, are a serious complication of liver transplantation.  They are responsible for increased morbidity and mortality and lead to rehospitalization, longer lengths of stay, and prolonged intravenous antimicrobial therapy.  Retransplantation is sometimes needed.  Limited data is available on the microbiology of bilomas and the optimal empiric antimicrobial therapy.

    Methods:

    A retrospective review of all orthotopic liver transplants (OLT) performed at University Hospital, an inner city tertiary care Liver Transplant Center, from January 1, 2002 through December 31, 2012 was conducted (n=732). Combined liver and kidney transplants were excluded, leaving 695 cases for analysis. Patients with one or more post-transplant bilomas were identified. Biloma was defined as an intra- or extrahepatic fluid collection on CT scan, ultrasound or cholangiography.  Patients found to have bilomas underwent percutaneous drainage procedures to guide antimicrobial therapy and to evacuate collections.  Culture data was reviewed and the infecting pathogens and antibiograms were identified.

    Results:

    5.17% (36/695) patients developed biloma following OLT

    33% (12/36) were monomicrobial; 66% (24/36) were polymicrobial.  61% (22/36) had an enterococcal isolate, making it the most common pathogen recovered.  36.3%(8/22) had vancomycin resistant enterococcus(VRE) isolated; two of these patients expired within eight weeks.  None of the patients received empiric antimicrobials with activity against VRE prior to identification of the pathogen.

    Conclusion:

    The majority of infected bilomas exhibit a polymicrobial etiology. The most prevalent organism was Enterococcus and over 30%  were vancomycin resistant.  Our data suggest that empiric therapy for bilomas in OLT should include an agent active against enterococci, and in some cases, vancomycin-resistant enterococci.  Further studies are needed to better define the epidemiology, risk factors and treatment outcomes for bilomas  following OLT.

    Meredith Schade, MD1, Dorian Wilson, MD2 and Lisa Dever, MD3, (1)Internal Medicine, UMDNJ-New Jersey Medical School, Newark, NJ, (2)Surgery, UMDNJ-New Jersey Medical School, Newark, NJ, (3)Infectious Diseases, UMDNJ-New Jersey Medical School, Newark, NJ

    Disclosures:

    M. Schade, None

    D. Wilson, None

    L. Dever, None

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