Bacterial infection is most common in the first month, with gram-negative enteric organisms accounting for over 50 percent. Although gram-negative organisms predominate (especially Pseudomonas aeruginosa), gram-positive and anaerobic organisms are not uncommon. Broad-spectrum antibiotics should be considered early in the patient's course. Bacterial infection is frequently associated with the vascular or biliary anastomosis, especially hepatic artery thrombosis but also portal vein thrombosis. Ischemia may lead to bile leak and abscess or deep soft tissue infection. After the first month, the incidence of bacterial infections decreases and the incidence of opportunistic infection increases, but vigilance for bacterial illnesses should remain high. Community-acquired pneumonia is most likely due to Streptococcus pneumoniae and Haemophilus influenzae. Meningitis shows a high preponderance of Listeria monocytogenes as well as S. pneumoniae, Staphylococcus aureus, and gram-negative rods. Empiric antibiotic coverage should be aimed at this flora.
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