Role of Clinical Pharmacist in Evaluating Risk factors for Multidrug Resistant Bacteria after Living Donor Liver Transplantation

Abstract

Liver transplantation is indicated in end stage liver disease, the most common indication in adults is cirrhosis (Clavien and Trotter, 2012). Liver transplantation should lead to prolonged survival and improved quality of life (Varma et al., 2011). Of the common complications that occur in the recipient after LDLT are wound infections and pneumonia (Clavien and Trotter, 2012). It is estimated that up to 80% of liver recipients will develop at least one infection during the first year after transplantation, and. While most are successfully treated, some will result in death. Indeed, opportunistic infections are a leading cause of death during the first three years after liver transplantation (Romero and Razonable, 2011). Antibiotic misuse or over use may increase the emergence of resistance bacteria and as a result the selection pressure on physician who tends to prescribe newer broad spectrum agents for excessive period of time (Ibrahim and Ayad, 2012). Antibiotic resistance is currently the greatest challenge to effective treatment of infections globally (Bisht, et al., 2009). Strict guidelines and valid polices should be implemented in hospitals to decrease the antibiotic misuse and decrease the risk of microbial resistance against the current known antibiotics (Ibrahim and Ayad, 2012). Pharmacist play an important role in reducing antibiotic resistance by counseling of individual patient on appropriate use of antibiotics, attending wards rounds and acting as a point of communication between pharmacy, microbiology and infection control teams, he can also prepare evidence based local prescribing guidelines for antibiotics, monitor institutional antibiotic use and provide educational and training program in antibiotic therapy for doctors, nurses, pharmacists and medical and pharmacy students (Bisht, et al., 2009). Pharmacist can fulfill a vital function in modern national health service hospitals as key members of the infection control team with overall responsibility for initiatives to promote rational antibiotic prescribing. Evidence of the impact of contributing pharmacist on clinical, microbiological and financial outcomes is presented along with examples of innovative practice (Hand, 2007).