369. Effect of Glucose Control on the Incidence of Surgical Site Infection Following Liver Transplantation
Session: Poster Abstract Session: HAI: Surgical Site Infections
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • ID Week Poster 2015.pdf (349.2 kB)
  • Background:

    Surgical site infection (SSI) is a common postoperative complication following liver transplantation (LT) that contributes to patient morbidity and mortality. Elevated blood glucose (BG) has been associated with increased risk of SSI, including SSI following LT. However, the effect of intensive postoperative glucose control on the occurrence of SSI after LT has not been determined.

    Methods:

    A randomized controlled clinical trial comparing intensive glucose management (IGM) and conventional glucose management (CGM) following LT conducted at our institution did not demonstrate reduction of a 90-day composite outcome of infection, rejection, or re-hospitalization. A substudy was undertaken to assess the effect of IGM on the incidence of SSI after LT. 197 patients received either IGM (n=97, target BG 90-120 mg/dL) or CGM (n=100, target BG 120-150 mg/dL in the intensive care unit and target BG 140-180 mg/dL on the floor) during the hospital stay following LT. Occurrence of SSI within 30 days of LT was determined via retrospective chart review using definitions of the National Healthcare Safety Network. Unadjusted Cox proportional hazards regression models were used to compare the risk of SSI between the IGM and CGM groups. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated.  

    Results:

    Mean BG during the hospital stay after LT was 134 mg/dL in the IGM group and 158 mg/dL in the CGM group (P<0.001). Fifteen of the 97 participants in the IGM group (15.5%) developed a SSI compared to 9 of the 100 patients (9.0%) in the CGM group. This difference did not approach statistical significance (RR=1.74, 95% CI; 0.77-4.13, P=0.18). When evaluating organ/space SSI as a secondary outcome, there was not a notable difference between the intensive (7/97, 7.2%) and conventional (6/100, 6.0%) glucose management groups (RR=1.19, 95% CI: 0.40-3.69, P=0.75). No patient developed a deep incisional SSI.

    Conclusion:

    Postoperative intensive glucose management during the transplant hospitalization does not reduce the incidence of SSI after LT.

    Hilary P. Steele, MD, MPH1, Walter C. Hellinger, MD2, Michael G. Heckman, MS3, Colleen S. Thomas, MS3, Kaniksha S. Desai, MD4, Andrew P. Keaveny, MD5, Juan M. Canabal, MD6, C. Burcin Taner, MD7, Gunjan Y. Gandhi, MD8 and Shon E. Meek, MD, PhD4, (1)Division of Internal Medicine, Mayo Clinic, Jacksonville, FL, (2)Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL, (3)Section of Biostatistics, Mayo Clinic, Jacksonville, FL, (4)Division of Endocrinology, Mayo Clinic, Jacksonville, FL, (5)Division of Transplant Medicine, Mayo Clinic, Jacksonville, FL, (6)Division of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, (7)Division of Transplantation Surgery, Mayo Clinic, Jacksonville, FL, (8)Division of Endocrinology, Allina Health, St. Paul, MN

    Disclosures:

    H. P. Steele, None

    W. C. Hellinger, None

    M. G. Heckman, None

    C. S. Thomas, None

    K. S. Desai, None

    A. P. Keaveny, None

    J. M. Canabal, None

    C. B. Taner, None

    G. Y. Gandhi, None

    S. E. Meek, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.