Cinar Gule, Kalkan İrem Akdemir, Azap Alpay, Kirimker Onur Elvan, Balci Deniz, Keskin Onur, Yuraydin Cihan, Ormeci Necati, Dokmeci Abdulkadir
Clinical Microbiology and Infectious Diseases Department, Ankara University School of Medicine, Ankara, Turkey.
Clinical Microbiology and Infectious Diseases Department, Ankara University School of Medicine, Ankara, Turkey.
Transplant Proc. 2019 Sep;51(7):2461-2465. doi: 10.1016/j.transproceed.2019.02.050.
Carbapenemase-producing Enterobacteriacea (CPE) cause serious and life-threatening infections. They are resistant to carbapenems and many other classes of commonly used antimicrobial agents; therefore, managing infections caused by them poses a substantial challenge in clinical practice. They can also cause morbidity and mortality in patients with liver transplant. A retrospective analysis of CPE culture-positive patients with a history of liver transplant can help to examine the epidemiology and microbiology of these bacteria, as well as gain information on the possible infection sources, susceptibility patterns, and expected mortality in infected populations. In addition, study of these bacteria could help formulate a consensus on the appropriate use of empirical and directed antibiotic therapy, which can effectively reduce infections in these patients. We reviewed the medical records of 142 subjects who underwent liver transplantation at Ankara University Hospital, a 1900-bed tertiary care university hospital, in Ankara, Turkey, between January 2014 and August 2018. Patients showing signs of infection with culture positivity for CPE-producing organisms were included from the study. Statistical analysis was performed and a value of P < .05 is considered statistically significant. In most cases, the source of infection was the abdomen. Klebsiella species was also predominant in these cases. Model for End-Stage Liver Disease scores and length of hospital stay were higher and statistically significant when compared to patients who were CPE negative. Mortality was highest in the CPE-positive group. Infection is the most important cause of mortality and morbidity after liver transplantation and increases the cost of treatment. Regarding the culture sensitivity patterns and resistance mode, empirical therapy with carbapenems does not produce a solid result. The high mortality observed with these infections reflects very limited therapeutic options.
产碳青霉烯酶肠杆菌科细菌（CPE）可引发严重且危及生命的感染。它们对碳青霉烯类药物以及许多其他常用抗菌药物具有耐药性；因此，在临床实践中，处理由它们引起的感染构成了重大挑战。它们还可导致肝移植患者发病和死亡。对有肝移植病史且CPE培养呈阳性的患者进行回顾性分析，有助于研究这些细菌的流行病学和微生物学情况，以及获取有关可能的感染源、药敏模式和感染人群预期死亡率的信息。此外，对这些细菌的研究有助于就经验性和针对性抗生素治疗的合理使用达成共识，从而有效减少这些患者的感染。我们回顾了2014年1月至2018年8月期间在土耳其安卡拉拥有1900张床位的三级护理大学医院——安卡拉大学医院接受肝移植的142名患者的病历。本研究纳入了出现感染迹象且CPE产生菌培养呈阳性的患者。进行了统计分析，P值<0.05被认为具有统计学意义。在大多数情况下，感染源为腹部。在这些病例中，克雷伯菌属也占主导地位。与CPE阴性患者相比，终末期肝病模型评分和住院时间更高且具有统计学意义。CPE阳性组的死亡率最高。感染是肝移植后发病和死亡的最重要原因，并增加了治疗成本。关于培养药敏模式和耐药模式，使用碳青霉烯类药物进行经验性治疗效果不佳。这些感染所观察到的高死亡率反映出治疗选择非常有限。
