Santoro-Lopes Guilherme, de Gouvêa Erika Ferraz
Guilherme Santoro-Lopes, Erika Ferraz de Gouvêa, Infectious Diseases Clinic, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ-CEP 21941-913, Brazil.
World J Gastroenterol. 2014 May 28;20(20):6201-10. doi: 10.3748/wjg.v20.i20.6201.
Bacterial infections are a leading cause of morbidity and mortality among solid organ transplant recipients. Over the last two decades, various multidrug-resistant (MDR) pathogens have emerged as relevant causes of infection in this population. Although this fact reflects the spread of MDR pathogens in health care facilities worldwide, several factors relating to the care of transplant donor candidates and recipients render these patients particularly prone to the acquisition of MDR bacteria and increase the likelihood of MDR infectious outbreaks in transplant units. The awareness of this high vulnerability of transplant recipients to infection leads to the more frequent use of broad-spectrum empiric antibiotic therapy, which further contributes to the selection of drug resistance. This vicious cycle is difficult to avoid and leads to a scenario of increased complexity and narrowed therapeutic options. Infection by MDR pathogens is more frequently associated with a failure to start appropriate empiric antimicrobial therapy. The lack of appropriate treatment may contribute to the high mortality occurring in transplant recipients with MDR infections. Furthermore, high therapeutic failure rates have been observed in patients infected with extensively-resistant pathogens, such as carbapenem-resistant Enterobacteriaceae, for which optimal treatment remains undefined. In such a context, the careful implementation of preventive strategies is of utmost importance to minimize the negative impact that MDR infections may have on the outcome of liver transplant recipients. This article reviews the current literature regarding the incidence and outcome of MDR infections in liver transplant recipients, and summarizes current preventive and therapeutic recommendations.
细菌感染是实体器官移植受者发病和死亡的主要原因。在过去二十年中，各种多重耐药（MDR）病原体已成为该人群感染的相关病因。尽管这一事实反映了MDR病原体在全球医疗机构中的传播，但与移植供体候选者和受者护理相关的几个因素使这些患者特别容易感染MDR细菌，并增加了移植单位发生MDR感染暴发的可能性。意识到移植受者对感染的高度易感性导致更频繁地使用广谱经验性抗生素治疗，这进一步促使耐药性的产生。这种恶性循环难以避免，导致情况更加复杂，治疗选择更加有限。MDR病原体感染更常与未能开始适当的经验性抗菌治疗有关。缺乏适当的治疗可能导致MDR感染的移植受者出现高死亡率。此外，在感染广泛耐药病原体（如碳青霉烯类耐药肠杆菌科细菌）的患者中观察到高治疗失败率，对此类病原体的最佳治疗方法仍不明确。在这种情况下，谨慎实施预防策略对于将MDR感染对肝移植受者预后的负面影响降至最低至关重要。本文综述了关于肝移植受者MDR感染的发病率和预后的当前文献，并总结了当前的预防和治疗建议。
