RODRIGUEZ CI, MUNOZ P, ALCALA L, ALVARADO N, CATALINA V, BANARES R, MARTINEZ J, BOUZA E; Interscience Conference on Antimicrobial Agents and Chemotherapy (43rd: 2003: Chicago, Ill.).
Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2003 Sep 14-17; 43: abstract no. K-141.
Hospital Gregorio Maranon, Madrid, Spain.
BACKGROUND: MARS is a new haemodialysis based procedure used as extracorporeal liver support therapy in patients with hepatic failure and as bridge to transplantation. In MARS water soluble toxins and albumin-bound hepatic products are removed. It is performed through a femoral catheter as a conventional haemodialysis with one open blood circuit and a closed albumin circuit. We describe our initial experience on infectious complications of this procedure. METHODS: During the period Feb 2002-Jan 2003, 19 patients required a MARS procedure. All patients were prospectively followed by ID clinicians and complications recorded in a pre-established protocol. CDC criteria were used for syndrome definitions. RESULTS: Mean age was 44 y (4-68) and 68% were male. Mean number of sessions per patient was 3 (1-9). Indications for MARS were: acute alcoholic hepatitis (8, 42%), acute liver failure (3, 16%), acute on chronic liver failure (2,10%), refractory pruritus (2,10%), toxic hepatitis (2,10%), 1 severe hepatic sickling and 1 liver transplant failure. Before MARS, 7 (37%) patients had an infection: pneumonia (2), catheter-related bacteremia (2), SBP (1), osteomyelitis (1) and CMV infection (1). During MARS treatment, 5 patients developed an infection (26%): SBP (2), urinary tract infection (1) and jugular catheter-related bacteremia (2). Isolated pathogens were P. aeruginosa (5), E. coli (2), Enterococcus (2), S. viridans (1), methicillin-S S. aureus (1) and CMV (1). None of these infections were clearly related to the MARS procedure itself but to the underlying critical condition of the patients. 10 patients died (8 of them with no infections), 2 reached liver transplantation and 7 were discharged in good condition. CONCLUSION: Patients that need MARS support suffer a high rate of infectious complications, but none of them could be attributed to the procedure itself. Preemptive broad-spectrum antimicrobial therapy should be considered in this population.
Publication Types:
Keywords:
- Acute Disease
- Albumins
- Antidotes
- Disease Progression
- Gastrointestinal Agents
- Humans
- Liver Failure
- Liver Failure, Acute
- Liver Transplantation
- Male
- Mars
- Renal Dialysis
- surgery
- transplantation
Other ID:
UI: 102265316
From Meeting Abstracts