Alborzi Clinical Microbiology Research Center, Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
Shiraz Organ Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
Microbiol Immunol. 2020 Jun;64(6):407-415. doi: 10.1111/1348-0421.12785. Epub 2020 May 18.
Liver transplantation (LT) is a potentially curative treatment for terminal stage hepatic diseases. Bacterial infections are the main causes of mortality and morbidity in the early period after LT. Identifying the risk factors could help in minimizing their development. We prospectively investigated the incidence, characteristics, and risk factors of bacterial infections among the recipients during hospitalization after LT and assigned a predictive score. All 389 consecutive adults who underwent LT at the main referral hospital of LT in Iran during 1 year were enrolled prospectively in a cohort study. Infection group consisted of 143 recipients (36.8%). Urinary tract and surgical site infections were the most frequent ones. Gram-negative bacteria were more prevalent than Gram-positive ones. Independent risk factors were female sex (relative risks = 2.13), age ≤ 43.5 years (3.70), hospital stay ≥ 9.5 days (5.22), abdominal reoperation (3.03), vancomycin-resistant Enterococci colonization (5.52), hospitalization 3 months prior to LT (3.25), mechanical ventilation ≥48 hr (4.93), and renal replacement therapies (13.40). We developed a risk score for the prediction of bacterial infections with an area under the receiver operating characteristic curve of 0.85 (95% CI, 0.81-0.89) with sensitivity of 88% and specificity of 64%. In the infection group, mortality was higher than in controls (18.9% vs. 2.0%) with longer hospitalization (16 vs. 10 days; P < 0.001). We detected a high rate of bacterial infections leading to longer hospital stay and higher mortality rate. The formulated risk score can help predict bacterial infections; however, it requires clinical validation in further studies.
肝移植（LT）是治疗终末期肝脏疾病的潜在根治方法。细菌感染是 LT 后早期患者死亡和发病的主要原因。确定这些危险因素有助于降低其发生率。我们前瞻性地调查了 LT 后住院期间患者细菌感染的发生率、特征和危险因素，并制定了预测评分。所有 389 例在伊朗主要 LT 转诊医院接受 LT 的连续成年患者均前瞻性纳入队列研究。感染组包括 143 例患者（36.8%）。尿路感染和手术部位感染最为常见。革兰氏阴性菌比革兰氏阳性菌更为常见。独立的危险因素为女性（相对风险=2.13）、年龄≤43.5 岁（3.70）、住院时间≥9.5 天（5.22）、腹部再次手术（3.03）、万古霉素耐药肠球菌定植（5.52）、LT 前 3 个月住院（3.25）、机械通气≥48 小时（4.93）和肾脏替代治疗（13.40）。我们制定了一个预测细菌感染的风险评分，其受试者工作特征曲线下面积为 0.85（95%置信区间，0.81-0.89），灵敏度为 88%，特异性为 64%。在感染组中，死亡率高于对照组（18.9% vs. 2.0%），住院时间更长（16 天 vs. 10 天；P<0.001）。我们发现细菌感染发生率较高，导致住院时间延长和死亡率增加。所制定的风险评分有助于预测细菌感染，但需要在进一步的研究中进行临床验证。
