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Prevention of bacterial infection in the transplant recipient. The role of selective bowel decontamination.

Bacterial infections during the first month after liver transplantation remain a serious problem despite perioperative administration of systemic broad-spectrum antibiotics. These infections usually have been caused by aerobic gram-negative bacilli from the alimentary tract, and the most promising approach during the past decade is to eliminate or suppress these organisms by SBD. Several centers that have used SBD for prophylaxis have reported favorable results, but only one of the studies has been prospective and randomized. Based on the limited information now available, it seems that the efficacy of SBD is dependent on eliminating or suppressing aerobic gram-negative bacilli by the time of transplant surgery. This is an especially important point because successful SBD requires at least several days of treatment, and there are practical problems initiating and maintaining SBD in advance of unscheduled cadaver liver transplantation. Key areas for investigation are to establish by appropriately designed studies the efficacy of SBD and to examine the importance of achieving SBD prior to transplantation surgery.