Perioperative antimicrobial prophylaxis strategies in pediatric liver transplantation: an intentional survey by IPTA's ID group.

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.
 
 
1.Do you perform liver transplants at your center?
2.In which region of the world do you work? 
3.In which country is your center located?
4.What is your specialty 
5.How many pediatric liver transplants are performed each year in your center (on average over the last 5 years)?
6.What proportion of pediatric liver transplants at your center are living-donor transplants?
7.Does your center perform screening for any multidrug resistant organisms (MDRO) in liver transplant candidates in your center?
8.For which pathogens below does your center perform testing? (select all that apply)
9.Does your center perform MRSA screening only in specific liver transplant candidates? (select all that apply)
10.When performed what type of lab test is used for MRSA? (select all that apply)
11.At what time points does your center perform MRSA screening evaluations? (select all that apply)
12.Does your center perform CRE screening only in specific liver trnasplant candidates? (select all that apply)
13.When preformed what type of lab test is used for CRE? (select all that apply)
14.At which timepoints does your center perform CRE screening evaluations? (select all that apply)
15.Does your center perform VRE screening only in specific liver transplant candidates? (select all that apply)
16.When performed what type of lab test is used for VRE? (select all that apply)
17.At which timepoints does your center perform VRE screening evaluations? (select all that apply)
18.Does your center perform ESBL screening only in specific liver transplant candidates? (select all that apply)
19.When performed what type of lab test is used for ESBL? (select all that apply)
20.At which timepoints does your center perform ESBL screening evaluations? (select all that apply)
21.Body site where the screening is performed? (select all that apply)
Nares
Rectal
Axillary
Inguinal
Stool
Surface
N/A
CRE
VRE
ESBL
MRSA
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.)
23.If yes, please specify which liver transplant candidates:
24.Does your center recommend selective bowel decontamination in liver transplant candidates?
25.If yes, please specify which liver transplant candidates:
26.If yes, what is the bowel decontamination regimen most frequently used at your center? (select all that apply)
27.Does your center have written guidelines for perioperative antimicrobial recommendations for liver transplantation?
28.If yes is it available to the public through an internet link?
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? 
30.What is the standard duration of antibiotic prophylaxis after liver transplantation (in patients without a proven/suspected infection?
31.At your institution, criteria used to prolong antimicrobial prophylaxis beyond the standard duration after liver transplantation include (several answers possible):
32.Does your center adapt your first line routine perioperative antibiotic prophylaxis regimen in case of MRSA infection, colonization, or screens positive for MRSA?
33.What conditions/factors impact the decision to change first line routine perioperative antibiotic prophylaxis regimen due to MRSA? (check all that apply)
34.If MRSA infection, colonization, or positive screen, which antibiotic would your center include in the prophylaxis regimen?
35.Does your center adapt your first line routine perioperative antibiotic prophylaxis regimen in case of ESBL infection, colonization, or positive screen?
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)
37.If ESBL infection, colonization, or positive screen, which antibiotic would your center include in the prophylaxis regimen?
38.Does your center adapt your first line routine perioperative antibiotic prophylaxis regimen in case of CRE infection, colonization, or positive screen?
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)
40.If CRE infection, colonization, or positive screen, which antibiotics would your center include prophylaxis regimen? (select all that apply)
41.Does your center adapt your first line routine perioperative antibiotic prophylaxis regimen in case of VRE infection, colonization, or positive screen?
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)
43.IF VRE infection, colonization or positive screen, which antibiotic would your center include in the prophylaxis regimen?
44.Does your center perform intraoperative cultures (ascites, liver biopsy, Roux en-Y loop, donor fluid) ?
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)?
46.Does your center systematically administer antifungal prophylaxis at liver transplantation?
47.If you systematically administer antifungal prophylaxis at liver transplantation, does your center do a:
48.If targeted strategy, to which patient does your center give antifungal prophylaxis? (select all that apply)
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)
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?
51.Do you want to receive the results of the survey? If yes, please include your email here: