*PURPOSE: This study aimed to describe the odds of bacterial infections and acute kidney injury (AKI) among surgical prophylactic antibacterial regimens in orthotopic liver transplant (OLT) recipients. *METHODS: This was a single-center, retrospective study of 322 adult patients who underwent OLT between 1/1/2015-11/1/2020. Patients received basiliximab or steroid induction and received antibacterials for at least 24 hours post-transplant. Patients were classified according to prophylactic regimen as follows: cefazolin (CFZ), piperacillin-tazobactam (PTZ), piperacillin-tazobactam and vancomycin (PTZ + VAN), ciprofloxacin and clindamycin (C+C), and other. The primary outcome was a composite of bacterial infections within 60 days post-transplant including primary invasive surgical site infection (SSI) and primary bloodstream infection. The OR of bacterial infection between three regimens (PTZ, PTZ + VAN, and any antibacterial plus vancomycin > 48 hours) relative to CFZ were calculated. AKI was analyzed as a secondary outcome. *RESULTS: See Table 1 for demographics. Bacterial infections developed in 5.6% (18/322) of patients within 60 days of transplant with a mean time from last antibacterial dose of 15.5 (14.0) days. SSI accounted for 88.9% of the infections. Re-transplant and Roux en Y anastomosis were more common among recipients with bacterial infections in the entire cohort. Of the regimens evaluated, only PTZ was associated with increased odds of bacterial infection (OR 3.09; 95% CI 1.22-10.66; Table 2). AKI developed in 63.7% (176/276) of patients. In univariable and multivariable analysis, PTZ + VAN and intraoperative blood product requirement > 4 units were associated with increased odds of AKI (Table 3). *CONCLUSIONS: Bacterial infections developed in a minority of OLT recipients and were more common among recipients receiving PTZ prophylaxis. Patient selection should be judicious when using PTZ + VAN due to risk of AKI. [

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]CITATION INFORMATION: Evans K., Harris M., Lee H., Hung F., Alexander B., Carugati M. Antibacterial Prophylaxis Regimens in Adult Orthotopic Liver Transplantation and Incidence of Post-Operative Bacterial Infections AJT, Volume 23, Issue 6, Supplement 1.

Kayla Evans PharmD

UF Health Shands Hospital

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