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肝移植患者的感染:活体供者受者可能更容易发生细菌/真菌感染。

Infections developing in patients undergoing liver transplantation: Recipients of living donors may be more prone to bacterial/fungal infections.

机构信息

Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, Bornova, Izmir, Turkey.

Department of General Surgery, Ege University School of Medicine, Bornova, Izmir, Turkey.

出版信息

Turk J Gastroenterol. 2020 Dec;31(12):894-901. doi: 10.5152/tjg.2020.19286.

Abstract

BACKGROUND/AIMS: Despite surgical advances in liver transplantation and effective prophylactic strategies, posttransplant infections are the most important cause of morbidity and mortality. Diagnosis and management of infections because of developing immunosuppression is difficult and adversely affects mortality. This study aimed to review bacterial and fungal infections in patients after liver transplantation and to reveal the resistance rates.

MATERIALS AND METHODS

A total of 107 patients who underwent liver transplantation between January 2017 and February 2018 were evaluated retrospectively with regard to demographic characteristics, causes of transplantation, conditions that may lead to infection, postoperative infections, pathogens, and resistance patterns.

RESULTS

Of the 107 patients who underwent liver transplantation, 48 (44.8%) had an infection. Bacterial infections were detected in 41% of the patients, and fungal infections were found in 13%. When we compared living and cadaveric transplants in terms of infection development, these rates were found to be 53% and 33%, respectively (p=0.034). No statistically significant results could be obtained when evaluating conditions such as sex, presence of underlying primary disease, Model for End-Stage Liver Disease MELD score, diabetes status, total parenteral nutrition, and risk factors for infection.

CONCLUSION

After liver transplantation, infections are often seen in the first month of the postoperative period. Knowing the most common pathogens and resistance states in this process reduces infection-related deaths by providing appropriate treatment regimens at the right time.

摘要

背景/目的:尽管肝移植手术取得了进展,并且采取了有效的预防策略,但术后感染仍是发病率和死亡率的最重要原因。由于免疫抑制的发展,感染的诊断和处理变得困难,并对死亡率产生不利影响。本研究旨在回顾肝移植后患者的细菌和真菌感染,并揭示耐药率。

材料和方法

回顾性评估了 2017 年 1 月至 2018 年 2 月期间接受肝移植的 107 例患者的人口统计学特征、移植原因、可能导致感染的情况、术后感染、病原体和耐药模式。

结果

在接受肝移植的 107 例患者中,有 48 例(44.8%)发生感染。41%的患者发生细菌感染,13%的患者发生真菌感染。当我们比较活体和尸体移植在感染发展方面的差异时,发现这些比率分别为 53%和 33%(p=0.034)。在评估性别、基础原发性疾病、终末期肝病模型 MELD 评分、糖尿病状态、全胃肠外营养和感染风险因素等情况时,没有得到统计学上的显著结果。

结论

肝移植后,感染通常发生在术后第一个月。了解此过程中最常见的病原体和耐药状态,可以通过在适当的时间提供适当的治疗方案,降低与感染相关的死亡。

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Risk factors for early bacterial infections in liver transplantation.肝移植早期细菌感染的危险因素
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