This 15 minute survey created by IPTA’s IDCARE committee aims to understand the current prophylaxis strategies for pediatric liver transplantation employed around the world.
  
Definitions
Perioperative prophylaxis: administration of antibiotic and/or antifungal medications in the time surrounding (prior, during, and post) liver transplantation with the goal of reducing postoperative infection risk.
 
MDRO: multidrug resistant organism: defined as microorganisms, predominately bacteria that are resistant to one or more classes of antimicrobial agents.
 
Extended-spectrum beta-lactamase (ESBL) producing Enterobacterales: ESBLs are enzymes that mediate resistance to extended-spectrum (third generation) cephalosporins (e.g., ceftazidime, cefotaxime, and ceftriaxone) and monobactums (e.g. aztreonam) but do not affect cephamycins (e.g. cefoxitin and cefotetan) or carbapenems (e.g., meropenem or impenem).
 
Carbapenem-resistant Enterobacterales (CRE): defined as Enterobacterales resistant to carbapenems (resistant to meropenem, ertapenem, or imipenem).
 
Methicillin-resistant S. aureus (MRSA): defined as Staphylococcus aureus resistant to oxacillin.
 
Vancomycin resistant enterococcus (VRE): defined as Enterococcus sp. resistant to vancomycin.
 
 

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* 1. Do you perform liver transplants at your center?

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* 2. In which region of the world do you work? 

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* 3. In which country is your center located?

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* 4. What is your specialty 

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* 5. How many pediatric liver transplants are performed each year in your center (on average over the last 5 years)?

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* 6. What proportion of pediatric liver transplants at your center are living-donor transplants?

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* 7. Does your center perform screening for any multidrug resistant organisms (MDRO) in liver transplant candidates in your center?

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* 8. For which pathogens below does your center perform testing? (select all that apply)

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* 9. Does your center perform MRSA screening only in specific liver transplant candidates? (select all that apply)

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* 10. When performed what type of lab test is used for MRSA? (select all that apply)

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* 11. At what time points does your center perform MRSA screening evaluations? (select all that apply)

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* 12. Does your center perform CRE screening only in specific liver trnasplant candidates? (select all that apply)

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* 13. When preformed what type of lab test is used for CRE? (select all that apply)

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* 14. At which timepoints does your center perform CRE screening evaluations? (select all that apply)

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* 15. Does your center perform VRE screening only in specific liver transplant candidates? (select all that apply)

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* 16. When performed what type of lab test is used for VRE? (select all that apply)

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* 17. At which timepoints does your center perform VRE screening evaluations? (select all that apply)

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* 18. Does your center perform ESBL screening only in specific liver transplant candidates? (select all that apply)

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* 19. When performed what type of lab test is used for ESBL? (select all that apply)

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* 20. At which timepoints does your center perform ESBL screening evaluations? (select all that apply)

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* 21. Body site where the screening is performed? (select all that apply)

  Nares Rectal Axillary Inguinal Stool Surface N/A
CRE
VRE
ESBL
MRSA

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* 22. Does your center recommend pre-transplant prebiotics or probiotics to liver transplant candidates? 

(Probiotic are foods/supplements that contain live microorganisms intended to maintain/improve the "good" bacteria in the body. Prebiotics are foods (typically high-fiber foods) that act as human microflora.)

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* 23. If yes, please specify which liver transplant candidates:

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* 24. Does your center recommend selective bowel decontamination in liver transplant candidates?

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* 25. If yes, please specify which liver transplant candidates:

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* 26. If yes, what is the bowel decontamination regimen most frequently used at your center? (select all that apply)

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* 27. Does your center have written guidelines for perioperative antimicrobial recommendations for liver transplantation?

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* 28. If yes is it available to the public through an internet link?

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* 29. At your institution what is the first-line antibiotic regimen for perioperative prophylaxis (most frequent used choice) in a patient without an active infection at the time of liver transplantation and with no known antimicrobial allergies? 

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* 30. What is the standard duration of antibiotic prophylaxis after liver transplantation (in patients without a proven/suspected infection?

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* 31. At your institution, criteria used to prolong antimicrobial prophylaxis beyond the standard duration after liver transplantation include (several answers possible):

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* 32. Does your center adapt your first line routine perioperative antibiotic prophylaxis regimen in case of MRSA infection, colonization, or screens positive for MRSA?

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* 33. What conditions/factors impact the decision to change first line routine perioperative antibiotic prophylaxis regimen due to MRSA? (check all that apply)

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* 34. If MRSA infection, colonization, or positive screen, which antibiotic would your center include in the prophylaxis regimen?

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* 35. Does your center adapt your first line routine perioperative antibiotic prophylaxis regimen in case of ESBL infection, colonization, or positive screen?

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* 36. The decision to change the first line routine perioperative antibiotic prophylaxis regimen is based on positive results of ESBL screening in these conditions (check all that apply)

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* 37. If ESBL infection, colonization, or positive screen, which antibiotic would your center include in the prophylaxis regimen?

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* 38. Does your center adapt your first line routine perioperative antibiotic prophylaxis regimen in case of CRE infection, colonization, or positive screen?

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* 39. The decision to change the first line routine perioperative antibiotic prophylaxis regimen is based on positive results of CRE screening in these conditions (select all that apply)

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* 40. If CRE infection, colonization, or positive screen, which antibiotics would your center include prophylaxis regimen? (select all that apply)

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* 41. Does your center adapt your first line routine perioperative antibiotic prophylaxis regimen in case of VRE infection, colonization, or positive screen?

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* 42. The decision to change the first line routine perioperative antibiotic prophylaxis regimen is based on positive results of VRE screening in these conditions (select all that apply)

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* 43. IF VRE infection, colonization or positive screen, which antibiotic would your center include in the prophylaxis regimen?

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* 44. Does your center perform intraoperative cultures (ascites, liver biopsy, Roux en-Y loop, donor fluid) ?

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* 45. Does your center adapt the antibiotic prophylaxis according to intraoperative culture results (for example perioperative culture grows for Pseudomonas aeruginosa, initially not covered by your antibiotic/antifungal prophylaxis)?

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* 46. Does your center systematically administer antifungal prophylaxis at liver transplantation?

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* 47. If you systematically administer antifungal prophylaxis at liver transplantation, does your center do a:

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* 48. If targeted strategy, to which patient does your center give antifungal prophylaxis? (select all that apply)

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* 49. If antifungal prophylaxis is provided, which antifungal is routinely used at your center in the majority of liver transplant recipients? (select all that apply)

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* 50. If antifungal prophylaxis is provided, in general, what is the duration of antifungal prophylaxis after liver transplantation when no peri- or post-operative fungal cultures are positive?

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* 51. Do you want to receive the results of the survey? If yes, please include your email here:

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