Montasser Mohamed F, Abdelkader Nadia A, Abdelhakam Sara M, Dabbous Hany, Montasser Iman F, Massoud Yasmine M, Abdelmoaty Waleed, Saleh Shereen A, Bahaa Mohamed, Said Hany, El-Meteini Mahmoud
Mohamed F Montasser, Nadia A Abdelkader, Sara M Abdelhakam, Hany Dabbous, Iman F Montasser, Yasmine M Massoud, Waleed Abdelmoaty, Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt.
World J Hepatol. 2017 Jul 18;9(20):896-904. doi: 10.4254/wjh.v9.i20.896.
To determine risk factors, causative organisms and antimicrobial resistance of bacterial infections following living-donor liver transplantation (LDLT) in cirrhotic patients.
This prospective study included 45 patients with hepatitis C virus-related end-stage liver disease who underwent LDLT at Ain Shams Center for Organ Transplant, Cairo, Egypt from January 2014 to November 2015. Patients were followed-up for the first 3 mo after LDLT for detection of bacterial infections. All patients were examined for the possible risk factors suggestive of acquiring infection pre-, intra- and post-operatively. Positive cultures based on clinical suspicion and patterns of antimicrobial resistance were identified.
Thirty-three patients (73.3%) suffered from bacterial infections; 21 of them had a single infection episode, and 12 had repeated infection episodes. Bile was the most common site for both single and repeated episodes of infection (28.6% and 27.8%, respectively). The most common isolated organisms were gram-negative bacteria. was the most common organism isolated from both single and repeated infection episodes (19% and 33.3%, respectively), followed by for repeated infections (11.1%), and for single infections (19%). Levofloxacin showed high sensitivity against repeated infection episodes ( = 0.03). , and were multi-drug resistant (MDR). Pre-transplant hepatocellular carcinoma (HCC) and duration of drain insertion (in days) were independent risk factors for the occurrence of repeated infection episodes ( = 0.024).
MDR gram-negative bacterial infections are common post-LDLT. Pre-transplant HCC and duration of drain insertion were independent risk factors for the occurrence of repeated infection episodes.
确定肝硬化患者活体肝移植（LDLT）后细菌感染的危险因素、致病微生物及抗菌药物耐药情况。
这项前瞻性研究纳入了2014年1月至2015年11月在埃及开罗艾因·沙姆斯器官移植中心接受LDLT的45例丙型肝炎病毒相关终末期肝病患者。对患者在LDLT后的前3个月进行随访以检测细菌感染情况。对所有患者术前、术中和术后可能提示感染的危险因素进行检查。根据临床怀疑和抗菌药物耐药模式确定阳性培养结果。
33例患者（73.3%）发生细菌感染；其中21例有单次感染发作，12例有反复感染发作。胆汁是单次和反复感染发作最常见的部位（分别为28.6%和27.8%）。最常见的分离菌为革兰氏阴性菌。 是单次和反复感染发作中最常见的分离菌（分别为19%和33.3%），其次是反复感染中的 （11.1%），单次感染中的 （19%）。左氧氟沙星对反复感染发作显示出高敏感性（ = 0.03）。 、 和 为多重耐药（MDR）。移植前肝细胞癌（HCC）和引流管插入时间（天数）是反复感染发作的独立危险因素（ = 0.024）。
LDLT后多重耐药革兰氏阴性菌感染常见。移植前HCC和引流管插入时间是反复感染发作的独立危险因素。
