Singh Nina, Wagener Marilyn M, Obman Asia, Cacciarelli Thomas V, de Vera Michael E, Gayowski Timothy
Veterans Affairs Medical Center, Pittsburgh, PA 15240, USA. nis5+@pitt.edu
Liver Transpl. 2004 Jul;10(7):844-9. doi: 10.1002/lt.20214.
During the 1990s, gram-positive bacteria emerged as major pathogens after liver transplantation. We sought to determine whether the pathogens associated with bacteremias in liver transplant recipients have changed. Patients included 233 liver transplant recipients transplanted between 1989 and 2003. The proportion of all infections due to bacteremias increased significantly over time (P <.0001). Of other major infections, a trend toward a decrease in fungal infections (P =.089) and a significant decrease in cytomegalovirus (CMV) disease (P =.0004) were documented. Whereas the proportion of bacteremias due to gram-negatives increased from 25% in the period of 1989-1993 to 51.8% in 1998-03, that of gram-positive bacteria decreased from 75% in the period of 1989-93 to 48.2% in the period of 1998-2003. Methicillin-resistant Staphylococcus aureus (MRSA), Klebsiella pneumoniae, and Pseudomonas aeruginosa were the most frequent pathogens in bacteremic patients. The incidence of bacteremias due to MRSA and Pseudomonas aeruginosa has remained unchanged (P <.20); however, that due to enteric gram-negative bacteria, particularly Klebsiella pneumoniae has increased (P =.02). Klebsiella pneumoniae isolates in the current quartile were not clonally related. In conclusion, bacteremias as a proportion of all infections in liver transplant recipients have increased significantly over time, due in part to a decline in infections due to other major pathogens, e.g., fungi, primarily Candida species, and CMV. Gram-negative bacteria have emerged as predominant pathogens in bacteremic liver transplant recipients.
在20世纪90年代，革兰氏阳性菌成为肝移植后的主要病原体。我们试图确定肝移植受者中与菌血症相关的病原体是否发生了变化。研究对象包括1989年至2003年间接受肝移植的233名患者。菌血症导致的所有感染比例随时间显著增加（P<.0001）。在其他主要感染中，真菌感染呈下降趋势（P =.089），巨细胞病毒（CMV）疾病显著减少（P =.0004）。革兰氏阴性菌导致的菌血症比例从1989 - 1993年期间的25%增至1998 - 2003年期间的51.8%，而革兰氏阳性菌导致的菌血症比例则从1989 - 1993年期间的75%降至1998 - 2003年期间的48.2%。耐甲氧西林金黄色葡萄球菌（MRSA）、肺炎克雷伯菌和铜绿假单胞菌是菌血症患者中最常见的病原体。MRSA和铜绿假单胞菌导致的菌血症发病率保持不变（P<.20）；然而，肠道革兰氏阴性菌，尤其是肺炎克雷伯菌导致的菌血症发病率有所增加（P =.02）。当前四分位数中的肺炎克雷伯菌分离株并非克隆相关。总之，随着时间推移，菌血症在肝移植受者所有感染中所占比例显著增加，部分原因是其他主要病原体（如真菌，主要是念珠菌属和CMV）导致的感染有所下降。革兰氏阴性菌已成为菌血症肝移植受者中的主要病原体。
