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肝移植术后早期的细菌感染监测

Bacterial infection monitoring in the early period after liver transplantation.

作者信息

Lee Ji Soo, Lee Seung Hwan, Kim Kyeong Sik, Gil Eun Mi, Choi Gyu-Seoung, Kim Jong Man, Peck Kyong Ran, Kwon Choon Hyuck David, Joh Jae-Won, Lee Suk-Koo

机构信息

Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine,Seoul, Korea.

出版信息

Ann Surg Treat Res. 2018 Mar;94(3):154-158. doi: 10.4174/astr.2018.94.3.154. Epub 2018 Feb 28.

DOI:10.4174/astr.2018.94.3.154
PMID:29520350
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5842088/
Abstract

PURPOSE

Infection remains the main cause of morbidity and mortality in liver transplantation (LT) recipients; however infection is notoriously difficult to diagnose because its usual signs and symptoms of infection may be masked or absent. This study comprises an analysis of bacterial infections in the early period after LT.

METHODS

This is a study of 129 adults who underwent LT from January 2013 to December 2013, and it includes patients who were followed daily from the day of transplantation to 1-week posttransplantation using bacteriological cultures of blood, urine, sputum, and drained ascites.

RESULTS

The following factors were significantly different between the positive and negative culture groups: living donor LT . deceased donor LT (odds ratio [OR], 3.269; P = 0.003), model for end-stage liver disease score (OR, 4.364; P < 0.001), and Child-Pugh classification (P = 0.007). Neither positive culture nor negative culture was associated with infection within 4 weeks of surgery (P = 0.03), and most events were due to surgical complications (75%).

CONCLUSION

Since the full effect of immunosuppression is not yet present during the first month after LT, we suggest that the number of bacterial culture test could be reduced such that they are performed every other day depending on patient's situation.

摘要

目的

感染仍是肝移植(LT)受者发病和死亡的主要原因;然而,感染 notoriously 难以诊断,因为其常见的感染体征和症状可能被掩盖或不存在。本研究包括对 LT 术后早期细菌感染的分析。

方法

这是一项对 2013 年 1 月至 2013 年 12 月期间接受 LT 的 129 名成年人的研究,包括从移植当天到移植后 1 周每天进行随访的患者,使用血液、尿液、痰液和引流腹水的细菌培养。

结果

阳性和阴性培养组之间的以下因素存在显著差异:活体供体 LT. 已故供体 LT(优势比[OR],3.269;P = 0.003)、终末期肝病评分模型(OR,4.364;P < 0.001)和 Child-Pugh 分类(P = 0.007)。阳性培养和阴性培养均与术后 4 周内的感染无关(P = 0.03),大多数事件是由于手术并发症(75%)。

结论

由于 LT 后第一个月内免疫抑制的全部效果尚未显现,我们建议可以减少细菌培养测试的次数,根据患者情况每隔一天进行一次。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a428/5842088/2c2d49f0c656/astr-94-154-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a428/5842088/51da93e0aa2d/astr-94-154-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a428/5842088/2c2d49f0c656/astr-94-154-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a428/5842088/51da93e0aa2d/astr-94-154-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a428/5842088/2c2d49f0c656/astr-94-154-g002.jpg

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本文引用的文献

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Oral Valganciclovir as a Preemptive Treatment for Cytomegalovirus (CMV) Infection in CMV-Seropositive Liver Transplant Recipients.口服缬更昔洛韦作为巨细胞病毒(CMV)血清学阳性肝移植受者CMV感染的抢先治疗方法
PLoS One. 2015 May 5;10(5):e0123554. doi: 10.1371/journal.pone.0123554. eCollection 2015.
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Clinical significance of surveillance culture in liver transplant recipients.肝移植受者监测培养的临床意义
Transplant Proc. 2014 Apr;46(3):828-31. doi: 10.1016/j.transproceed.2013.11.030.
3
Bacterial infections in the early period after liver transplantation: etiological agents and their susceptibility.
肝移植术后早期细菌感染:病原体及其药敏。
Med Sci Monit. 2009 Dec;15(12):CR628-37.
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Infection in solid-organ transplant recipients.实体器官移植受者的感染
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Infection in organ-transplant recipients.器官移植受者中的感染
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Infectious complications in solid organ transplant recipients.
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