Chueiri Neto Felicio, Emídio Lucas Amaral, Perales Simone Reges, Stucchi Raquel Silveira Bello, Dragosavac Desanka, Falcao Antonio Luis Eiras, Osni Leão Perin Paulo, Boin Ilka de Fátima Santana Ferreira, de Ataide Elaine Cristina
Unit of Liver Transplantation, State University of Campinas, São Paulo, Brazil.
Intensive Care Unit, State University of Campinas, São Paulo, Brazil.
Transplant Proc. 2019 Jul-Aug;51(6):1972-1977. doi: 10.1016/j.transproceed.2019.03.040.
Bloodstream infections are a major factor contributing to morbidity and mortality following liver transplantation. The increasing occurrence of multidrug-resistant bloodstream infections represents a challenge for the prevention and treatment of those infections. The aim of this study was to evaluate the occurrence and microbiological profile of bloodstream infections during the early postoperative period (from day 0 to day 60) in patients undergoing liver transplantation from January 2005 to June 2016 at the State University of Campinas General Hospital. A total of 401 patients who underwent liver transplantation during this period were included in the study. The most common cause of liver disease was hepatitis C virus cirrhosis (34.01%), followed by alcoholic disease (16.24%). A total of 103 patients had 139 microbiologically proven bloodstream infections. Gram-negative bacteria were isolated in 63.31% of the cases, gram-positive bacteria in 28.78%, and fungi in 7.91%. Fifty-six infections (43.75%) were multidrug-resistant bacteria, and 72 (56.25%) were not. There was no linear trend concerning the occurrence of multidrug-resistant organisms throughout the study period. Patients with multidrug-resistant bloodstream infections had a significantly lower survival rate than those with no bloodstream infections and those with non-multidrug-resistant bloodstream infections. In conclusion, the occurrence of bloodstream infections during the early postoperative period was still high compared with other profile patients, as well as the rates of multidrug-resistant organisms. Even though the occurrence of multidrug resistance has been stable for the past decade, the lower survival rates associated with that condition and the challenge related to its treatment are of major concern.
血流感染是肝移植术后导致发病和死亡的主要因素。多重耐药血流感染的发生率不断上升，给这些感染的预防和治疗带来了挑战。本研究的目的是评估2005年1月至2016年6月在坎皮纳斯州立大学总医院接受肝移植的患者术后早期（从第0天至第60天）血流感染的发生率及微生物学特征。本研究纳入了在此期间接受肝移植的401例患者。肝病的最常见病因是丙型肝炎病毒肝硬化（34.01%），其次是酒精性疾病（16.24%）。共有103例患者发生了139次经微生物学证实的血流感染。63.31%的病例分离出革兰氏阴性菌，28.78%为革兰氏阳性菌，7.91%为真菌。56例感染（43.75%）为多重耐药菌，72例（56.25%）不是。在整个研究期间，多重耐药菌的发生没有线性趋势。多重耐药血流感染患者的生存率显著低于无血流感染患者和非多重耐药血流感染患者。总之，与其他特征患者相比，术后早期血流感染的发生率以及多重耐药菌的发生率仍然很高。尽管多重耐药的发生率在过去十年中一直稳定，但与之相关的较低生存率以及治疗方面的挑战仍是主要关注点。
