George D L, Arnow P M, Fox A S, Baker A L, Thistlethwaite J R, Emond J C, Whitington P F, Broelsch C E
Department of Medicine, University of Chicago Hospitals, Illinois.
Rev Infect Dis. 1991 May-Jun;13(3):387-96. doi: 10.1093/clinids/13.3.387.
A retrospective survey was undertaken to characterize the epidemiology of bacterial infection in 79 patients who underwent 103 operations for orthotopic liver transplantation. Fifty-four patients (68%) developed 115 bacterial infections (1.46 episodes per patient), and seven patients died as a result of these infections. Fifty-three percent of bacterial infections occurred within 2 weeks after transplantation and were designated as early infections. The most common sites of infection were the abdomen (35 cases), the bloodstream (31 cases), and the surgical wound (19 cases). Aerobic enteric gram-negative bacilli were the predominant pathogens, and other pathogenic organisms were enterococci, staphylococci, and Pseudomonas bacteria. Logistic regression analysis identified prolonged duration of surgery (greater than or equal to 8 hours) and an elevated bilirubin level (greater than or equal to 12 mg/dL) as risk factors for early bacterial infection at any site; risk factors for abdominal or wound infection were prolonged duration of surgery, increased operative transfusion requirement (greater than or equal to 2 blood volumes), and prior hepatobiliary surgery. Awareness of the sites, pathogens, and time of onset of bacterial infection provides a basis for improved prophylaxis and empiric therapy.
我们进行了一项回顾性调查，以描述79例接受103次原位肝移植手术患者的细菌感染流行病学特征。54例患者（68%）发生了115次细菌感染（每位患者1.46次发作），7例患者死于这些感染。53%的细菌感染发生在移植后2周内，被指定为早期感染。最常见的感染部位是腹部（35例）、血流（31例）和手术伤口（19例）。需氧肠道革兰氏阴性杆菌是主要病原体，其他致病生物是肠球菌、葡萄球菌和假单胞菌。逻辑回归分析确定手术时间延长（大于或等于8小时）和胆红素水平升高（大于或等于12mg/dL）是任何部位早期细菌感染的危险因素；腹部或伤口感染的危险因素是手术时间延长、手术输血需求量增加（大于或等于2个血容量）和既往肝胆手术。了解细菌感染的部位、病原体和发病时间为改进预防措施和经验性治疗提供了依据。
