Yamamoto Masaki, Takakura Shunji, Iinuma Yoshitsugu, Hotta Go, Matsumura Yasufumi, Matsushima Aki, Nagao Miki, Ogawa Kohei, Fujimoto Yasuhiro, Mori Akira, Ogura Yasuhiro, Kaido Toshimi, Uemoto Shinji, Ichiyama Satoshi
Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Department of Infectious Diseases, Kanazawa Medical University, Kanazawa, Japan.
PLoS One. 2015 Aug 31;10(8):e0136559. doi: 10.1371/journal.pone.0136559. eCollection 2015.
Surgical site infections (SSIs) are a major threat for liver transplant recipients. We prospectively studied SSIs after living donor liver transplantation (LDLT) at Kyoto University Hospital from April 2001 to March 2002 (1st period) and from January 2011 to June 2012 (2nd period). We investigated the epidemiology of SSIs after LDLT and determined the differences between the two periods. A total of 129 adult recipients (66 during the 1st period and 63 during the 2nd period) and 72 pediatric recipients (39 and 33) were included in this study. The SSI rates for each period were 30.3% (1st period) and 41.3% (2nd period) among the adult recipients and 25.6% and 30.3% among the pediatric recipients. The overall rates of 30-day mortality among adult transplant recipients with SSIs were 10.0% (1st period) and 3.9% (2nd period). No pediatric recipient died from SSIs after LDLT in either period. The incidence of Enterococcus faecium increased from 5.0% to 26.9% in the adults and from 10.0% to 40.0% in the pediatric patients. Extended-spectrum β-lactamase-producing Enterobacteriaceae were emerging important isolates during the 2nd period. For this period, a univariate analysis showed that ABO incompatibility (P = 0.02), total operation duration (P = 0.01), graft-to-recipient body weight ratio (GRWR [P = 0.04]), and Roux-en-Y biliary reconstruction (P<0.01) in the adults and age (P = 0.01) and NHSN risk index (P = 0.02) in the children were associated with SSI development. In a multivariate analysis, lower GRWR (P = 0.02) and Roux-en-Y biliary reconstruction (P<0.01) in the adults and older age (P = 0.01) in the children were independent risk factors for SSIs during the 2nd period. In conclusion, SSIs caused by antibiotic resistant bacteria may become a major concern. Lower GRWR and Roux-en-Y biliary reconstruction among adult LDLT recipients and older age among pediatric LDLT recipients increased the risk of developing SSIs after LDLT.
手术部位感染（SSIs）对肝移植受者构成重大威胁。我们对2001年4月至2002年3月（第一阶段）以及2011年1月至2012年6月（第二阶段）在京都大学医院进行的活体肝移植（LDLT）术后的SSIs进行了前瞻性研究。我们调查了LDLT术后SSIs的流行病学情况，并确定了两个阶段之间的差异。本研究共纳入129名成年受者（第一阶段66名，第二阶段63名）和72名儿童受者（第一阶段39名，第二阶段33名）。成年受者各阶段的SSI发生率分别为30.3%（第一阶段）和41.3%（第二阶段），儿童受者分别为25.6%和30.3%。发生SSIs的成年移植受者30天死亡率总体分别为10.0%（第一阶段）和3.9%（第二阶段）。两个阶段均无儿童受者因LDLT术后的SSIs死亡。粪肠球菌的发生率在成人中从5.0%增至26.9%，在儿童患者中从10.0%增至40.0%。产超广谱β-内酰胺酶的肠杆菌科细菌在第二阶段成为重要的新兴分离菌。对于该阶段，单因素分析显示，成人中的ABO血型不相容（P = 0.02）、总手术时长（P = 0.01）、移植物与受者体重比（GRWR[P = 0.04]）以及Roux-en-Y胆肠重建术（P<0.01），儿童中的年龄（P = 0.01）和美国国家医疗安全网络（NHSN）风险指数（P = 0.02）与SSI的发生相关。多因素分析显示，成人中较低的GRWR（P = 0.02）和Roux-en-Y胆肠重建术（P<0.01），儿童中较高的年龄（P = 0.01）是第二阶段SSIs的独立危险因素。总之，由耐抗生素细菌引起的SSIs可能成为一个主要问题。成年LDLT受者中较低的GRWR和Roux-en-Y胆肠重建术，以及儿童LDLT受者中较高的年龄增加了LDLT术后发生SSIs的风险。
