Meng Die, Chang Rui, Zhu Ren
Hospital Infection Management Office, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China.
Ann Transl Med. 2022 Jul;10(14):804. doi: 10.21037/atm-22-3023.
Infection is the leading cause of short-term mortality after lung transplantation. This study aimed to investigate the epidemiology and risk factors of infection in Chinese lung transplant recipients.
A total of 107 lung transplant patients from 2016 to 2020 were included in this study. The basic data of patients were collected, combined with clinically relevant physiological and biochemical indicators and laboratory test results. Transplant patients with new infections 48 hours after surgery were included in the infected group, and the rest were in the Uninfected group. The risk factors of postoperative infection were analyzed between the two groups.
A total of 107 patients were included in the study, including 89 males and 18 females. All patients underwent lung transplantation. A total of 80 patients (74.8%) experienced a postoperative infection. Pathogenic microorganisms were found in 136 samples, predominantly in the sputum (n=120 samples; 88.2%). We detected 107 strains of Gram-negative bacteria (78.7%), including 30 strains of (22.1%) and 27 strains of (19.9%); 18 strains of Gram-positive bacteria (13.2%), including 11 strains of (8.1%) and 2 strains of (1.5%); and 11 strains (8.1%) were infected by fungi. There were 87 strains of multidrug-resistant bacteria. The main multidrug-resistant bacteria included 28 strains of (32.2%) and 25 strains of (28.7%). Multivariate analysis showed that ventilator use over 3 days was an independent risk factor for postoperative infection [odds ratio (OR): 4.94, 95% confidence interval (CI): 1.31 to 18.66, P=0.019].
The infection rate after lung transplantation in our hospital is similar to that of other lung transplantation studies, but higher than that following transplantation of other organs. The pathogens of postoperative infection were similar to those identified in other lung transplantation studies. Using a ventilator for more than 3 days is a risk factor for postoperative infection, suggesting that preventive measures for postoperative infection should be taken in such patients, and early postoperative discontinuation of the ventilator may reduce postoperative infection.
感染是肺移植术后短期死亡的主要原因。本研究旨在调查中国肺移植受者感染的流行病学及危险因素。
本研究纳入了2016年至2020年期间的107例肺移植患者。收集患者的基本资料，并结合临床相关的生理生化指标及实验室检查结果。术后48小时内发生新感染的移植患者纳入感染组，其余患者纳入未感染组。分析两组患者术后感染的危险因素。
本研究共纳入107例患者，其中男性89例，女性18例。所有患者均接受了肺移植。共有80例患者（74.8%）发生了术后感染。在136份样本中发现了致病微生物，主要存在于痰液中（n = 120份样本；88.2%）。我们检测到107株革兰氏阴性菌（78.7%），其中包括30株[（22.1%）]和27株[（19.9%）]；18株革兰氏阳性菌（13.2%），其中包括11株[（8.1%）]和2株[（1.5%）]；11株（8.1%）为真菌感染。有87株多重耐药菌。主要的多重耐药菌包括28株[（32.2%）]和25株[（28.7%）]。多因素分析显示，使用呼吸机超过3天是术后感染的独立危险因素[比值比（OR）：4.94，95%置信区间（CI）：1.31至18.66，P = 0.019]。
我院肺移植术后感染率与其他肺移植研究相似，但高于其他器官移植术后感染率。术后感染的病原体与其他肺移植研究中所鉴定的病原体相似。使用呼吸机超过3天是术后感染的危险因素，提示应对此类患者采取术后感染的预防措施，术后早期停用呼吸机可能会降低术后感染率。
