Freire Maristela Pinheiro, Oshiro Isabel C V S, Pierrotti Ligia C, Bonazzi Patricia R, de Oliveira Larissa M, Song Alice T W, Camargo Carlos H, van der Heijden Inneke M, Rossi Flavia, Costa Silvia F, DʼAlbuquerque Luiz A C, Abdala Edson
1 Infection Control Team, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil. 2 Department of Infectious Diseases, University of São Paulo School of Medicine, São Paulo, Brazil. 3 Liver and Intestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil. 4 Microbiology Research Laboratory-LIM54, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil. 5 Centro de Bacteriologia, Instituto Adolfo Lutz, São Paulo, Brazil. 6 Microbiology Laboratory, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil.
Transplantation. 2017 Apr;101(4):811-820. doi: 10.1097/TP.0000000000001620.
Carbapenem-resistant Enterobacteriaceae (CRE) is an emergent microorganism of infections after liver transplant (LT). The aim of this study was to analyze the risk factors for CRE acquisition and infection after LT.
This was a prospective cohort study involving patients who underwent LT in the 2010 to 2014 period. Surveillance cultures for CRE were collected immediately before LT and weekly thereafter until hospital discharge.
We analyzed 386 patients undergoing a total of 407 LTs. Before LT, 68 (17.6%) patients tested positive for CRE, 11 (16.2%) of those patients having CRE infection, whereas 119 (30.8%) patients acquired CRE after LT. Post-LT CRE infection was identified in 59 (15.7%) patients: Klebsiella pneumoniae was isolated in 83.2%; surgical site infection was the most common type of infection (46.7%). Multivariate analysis showed that post-LT dialysis was the only risk factor for post-LT CRE acquisition. Eighty-two percent of patients who underwent 3 or more post-LT dialysis sessions and acquired CRE before LT evolved with post-LT CRE infection. Other risk factors for CRE infection were acquisition of CRE post-LT, Model for End-Stage Liver Disease score greater than 32, combined transplantation, and reoperation. Patients who acquired CRE before LT had a high risk of developing CRE infection (P < 0.001).
Measures for minimizing that risk, including altering the antibiotic prophylaxis, should be investigated and implemented.
耐碳青霉烯类肠杆菌科细菌（CRE）是肝移植（LT）术后感染的一种新兴微生物。本研究的目的是分析肝移植术后获得性CRE感染的危险因素。
这是一项前瞻性队列研究，纳入了2010年至2014年期间接受肝移植的患者。在肝移植术前即刻采集CRE监测培养样本，术后每周采集一次，直至出院。
我们分析了386例患者，共进行了407次肝移植。肝移植术前，68例（17.6%）患者CRE检测呈阳性，其中11例（16.2%）患者发生CRE感染，而119例（30.8%）患者在肝移植术后获得CRE。59例（15.7%）患者被确诊为肝移植术后CRE感染：肺炎克雷伯菌分离率为83.2%；手术部位感染是最常见的感染类型（46.7%）。多因素分析显示，肝移植术后透析是肝移植术后获得性CRE的唯一危险因素。在肝移植术前接受3次或更多次透析且获得CRE的患者中，82%在肝移植术后发生了CRE感染。CRE感染的其他危险因素包括肝移植术后获得CRE、终末期肝病模型评分大于32、联合移植和再次手术。肝移植术前获得CRE的患者发生CRE感染的风险较高（P<0.001）。
应研究并实施将该风险降至最低的措施，包括改变抗生素预防方案。
