A randomized, prospective, double-blinded evaluation of selective bowel decontamination in liver transplantation

Walter C. Hellinger, Joseph D. Yao, Salvador Alvarez, Janis E. Blair, John J. Cawley, Carlos V. Paya, Peter C. O'Brien, James R. Spivey, Rolland Dickson, Denise Harnois, David D. Douglas, Christopher B. Hughes, Justin H Nguyen, David C. Mulligan, Jeffrey L. Steers

Research output: Contribution to journalArticle

88 Citations (Scopus)

Abstract

Background. Bacterial infection is a frequent, morbid, and mortal complication of liver transplantation. Selective bowel decontamination (SBD) has been reported to reduce the rate of bacterial infection after liver transplantation in uncontrolled trials, but benefits of this intervention have been less clear in controlled studies. Methods. Eighty candidates for liver transplantation were randomly assigned in a double-blinded fashion to an SBD regimen consisting of gentamicin 80 mg+polymyxin E 100 mg+nystatin 2 million units (37 patients) or to nystatin alone (43 patients). Both treatments were administered orally in 10 ml (increasing to 20 ml, according to predefined criteria), four times daily, through day 21 after transplantation. Anal fecal swab cultures were performed on days 0, 4, 7, and 21. Rates of infection, death, and charges for medical care were assessed from day 0 through day 60. Results. More than 85% of patients in both treatment groups began study treatment more than 3 days before transplantation. Rates of infection (32.4 vs. 27.9%), death (5.4 vs. 4.7%), or charges for medical care (median $194,000 vs. $163,000) were not reduced in patients assigned to SBD. On days 0, 4, 7, and 21, growth of aerobic gram-negative flora in fecal cultures of patients assigned to SBD was significantly less than that of patients taking nystatin alone; growth of aerobic gram-positive flora, anaerobes, and yeast was not significantly different. Conclusion. Routine use of SBD in patients undergoing liver transplantation is not associated with significant benefit.

Original languageEnglish (US)
Pages (from-to)1904-1909
Number of pages6
JournalTransplantation
Volume73
Issue number12
StatePublished - Jun 27 2002

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Decontamination
Liver Transplantation
Nystatin
Bacterial Infections
Transplantation
Colistin
Growth
Infection
Gentamicins
Therapeutics
Yeasts
Mortality

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Hellinger, W. C., Yao, J. D., Alvarez, S., Blair, J. E., Cawley, J. J., Paya, C. V., ... Steers, J. L. (2002). A randomized, prospective, double-blinded evaluation of selective bowel decontamination in liver transplantation. Transplantation, 73(12), 1904-1909.

A randomized, prospective, double-blinded evaluation of selective bowel decontamination in liver transplantation. / Hellinger, Walter C.; Yao, Joseph D.; Alvarez, Salvador; Blair, Janis E.; Cawley, John J.; Paya, Carlos V.; O'Brien, Peter C.; Spivey, James R.; Dickson, Rolland; Harnois, Denise; Douglas, David D.; Hughes, Christopher B.; Nguyen, Justin H; Mulligan, David C.; Steers, Jeffrey L.

In: Transplantation, Vol. 73, No. 12, 27.06.2002, p. 1904-1909.

Research output: Contribution to journalArticle

Hellinger, WC, Yao, JD, Alvarez, S, Blair, JE, Cawley, JJ, Paya, CV, O'Brien, PC, Spivey, JR, Dickson, R, Harnois, D, Douglas, DD, Hughes, CB, Nguyen, JH, Mulligan, DC & Steers, JL 2002, 'A randomized, prospective, double-blinded evaluation of selective bowel decontamination in liver transplantation', Transplantation, vol. 73, no. 12, pp. 1904-1909.
Hellinger WC, Yao JD, Alvarez S, Blair JE, Cawley JJ, Paya CV et al. A randomized, prospective, double-blinded evaluation of selective bowel decontamination in liver transplantation. Transplantation. 2002 Jun 27;73(12):1904-1909.
Hellinger, Walter C. ; Yao, Joseph D. ; Alvarez, Salvador ; Blair, Janis E. ; Cawley, John J. ; Paya, Carlos V. ; O'Brien, Peter C. ; Spivey, James R. ; Dickson, Rolland ; Harnois, Denise ; Douglas, David D. ; Hughes, Christopher B. ; Nguyen, Justin H ; Mulligan, David C. ; Steers, Jeffrey L. / A randomized, prospective, double-blinded evaluation of selective bowel decontamination in liver transplantation. In: Transplantation. 2002 ; Vol. 73, No. 12. pp. 1904-1909.
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abstract = "Background. Bacterial infection is a frequent, morbid, and mortal complication of liver transplantation. Selective bowel decontamination (SBD) has been reported to reduce the rate of bacterial infection after liver transplantation in uncontrolled trials, but benefits of this intervention have been less clear in controlled studies. Methods. Eighty candidates for liver transplantation were randomly assigned in a double-blinded fashion to an SBD regimen consisting of gentamicin 80 mg+polymyxin E 100 mg+nystatin 2 million units (37 patients) or to nystatin alone (43 patients). Both treatments were administered orally in 10 ml (increasing to 20 ml, according to predefined criteria), four times daily, through day 21 after transplantation. Anal fecal swab cultures were performed on days 0, 4, 7, and 21. Rates of infection, death, and charges for medical care were assessed from day 0 through day 60. Results. More than 85{\%} of patients in both treatment groups began study treatment more than 3 days before transplantation. Rates of infection (32.4 vs. 27.9{\%}), death (5.4 vs. 4.7{\%}), or charges for medical care (median $194,000 vs. $163,000) were not reduced in patients assigned to SBD. On days 0, 4, 7, and 21, growth of aerobic gram-negative flora in fecal cultures of patients assigned to SBD was significantly less than that of patients taking nystatin alone; growth of aerobic gram-positive flora, anaerobes, and yeast was not significantly different. Conclusion. Routine use of SBD in patients undergoing liver transplantation is not associated with significant benefit.",
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AU - Hellinger, Walter C.

AU - Yao, Joseph D.

AU - Alvarez, Salvador

AU - Blair, Janis E.

AU - Cawley, John J.

AU - Paya, Carlos V.

AU - O'Brien, Peter C.

AU - Spivey, James R.

AU - Dickson, Rolland

AU - Harnois, Denise

AU - Douglas, David D.

AU - Hughes, Christopher B.

AU - Nguyen, Justin H

AU - Mulligan, David C.

AU - Steers, Jeffrey L.

PY - 2002/6/27

Y1 - 2002/6/27

N2 - Background. Bacterial infection is a frequent, morbid, and mortal complication of liver transplantation. Selective bowel decontamination (SBD) has been reported to reduce the rate of bacterial infection after liver transplantation in uncontrolled trials, but benefits of this intervention have been less clear in controlled studies. Methods. Eighty candidates for liver transplantation were randomly assigned in a double-blinded fashion to an SBD regimen consisting of gentamicin 80 mg+polymyxin E 100 mg+nystatin 2 million units (37 patients) or to nystatin alone (43 patients). Both treatments were administered orally in 10 ml (increasing to 20 ml, according to predefined criteria), four times daily, through day 21 after transplantation. Anal fecal swab cultures were performed on days 0, 4, 7, and 21. Rates of infection, death, and charges for medical care were assessed from day 0 through day 60. Results. More than 85% of patients in both treatment groups began study treatment more than 3 days before transplantation. Rates of infection (32.4 vs. 27.9%), death (5.4 vs. 4.7%), or charges for medical care (median $194,000 vs. $163,000) were not reduced in patients assigned to SBD. On days 0, 4, 7, and 21, growth of aerobic gram-negative flora in fecal cultures of patients assigned to SBD was significantly less than that of patients taking nystatin alone; growth of aerobic gram-positive flora, anaerobes, and yeast was not significantly different. Conclusion. Routine use of SBD in patients undergoing liver transplantation is not associated with significant benefit.

AB - Background. Bacterial infection is a frequent, morbid, and mortal complication of liver transplantation. Selective bowel decontamination (SBD) has been reported to reduce the rate of bacterial infection after liver transplantation in uncontrolled trials, but benefits of this intervention have been less clear in controlled studies. Methods. Eighty candidates for liver transplantation were randomly assigned in a double-blinded fashion to an SBD regimen consisting of gentamicin 80 mg+polymyxin E 100 mg+nystatin 2 million units (37 patients) or to nystatin alone (43 patients). Both treatments were administered orally in 10 ml (increasing to 20 ml, according to predefined criteria), four times daily, through day 21 after transplantation. Anal fecal swab cultures were performed on days 0, 4, 7, and 21. Rates of infection, death, and charges for medical care were assessed from day 0 through day 60. Results. More than 85% of patients in both treatment groups began study treatment more than 3 days before transplantation. Rates of infection (32.4 vs. 27.9%), death (5.4 vs. 4.7%), or charges for medical care (median $194,000 vs. $163,000) were not reduced in patients assigned to SBD. On days 0, 4, 7, and 21, growth of aerobic gram-negative flora in fecal cultures of patients assigned to SBD was significantly less than that of patients taking nystatin alone; growth of aerobic gram-positive flora, anaerobes, and yeast was not significantly different. Conclusion. Routine use of SBD in patients undergoing liver transplantation is not associated with significant benefit.

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