Zhang Wei, Chen Ying, Zhang Yuntao, Wang Rongrong, Wang Weili, Bai Xueli, Liang Tingbo
Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Liver Transplant Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Infect Drug Resist. 2022 Aug 12;15:4487-4494. doi: 10.2147/IDR.S373773. eCollection 2022.
Perioperative prophylaxis, commonly with a third-generation cephalosporin plus ampicillin or piperacillin-tazobactam, is usually employed to prevent infections in liver transplantation (LT) recipients. Patients with a high Model for End-Stage Liver Disease (MELD) score have an increased infection risk after LT. However, whether carbapenems could be used as surgical prophylaxis in these high-risk patients remains unclear. Therefore, this study aimed at comparing the effectiveness of carbapenems with that of cephalosporin or piperacillin-tazobactam for surgical prophylaxis in high-risk LT recipients with a MELD score ≥30.
This retrospective study included adult patients with a MELD score ≥30 who underwent LT between May 2018 and September 2020. We comparatively analyzed the infection rate and outcome between patients using cefoperazone-sulbactam or piperacillin-tazobactam and those using carbapenems as surgical prophylaxis.
This study included 105 LT recipients. Seventy-eight and 27 patients used non-carbapenem and carbapenem antibiotics, respectively, as surgical prophylaxis. The corresponding infection incidence rates within 30 days were 38.5% and 66.7% (p = 0.011). Multivariate analysis revealed that reoperation and the Child-Pugh score were independent risk factors for infections within 30 days after LT. The following four risk factors were associated with the 180-day post-LT survival: MELD score, vascular complication, intra-abdominal bleeding, and infection with carbapenem-resistant organisms (CROs). There was no significant difference in CRO infection incidence between the carbapenem and non-carbapenem groups (18.5% vs 11.5%; p = 0.345).
Carbapenem use as surgical prophylaxis was not associated with infection incidence within 30 days after LT, 180-day post-LT survival or CRO infection. Therefore, carbapenems are not superior to cephalosporin or piperacillin-tazobactam for perioperative antibiotic prophylaxis in LT recipients with a MELD score ≥30.
肝移植（LT）受者通常采用围手术期预防措施，一般是使用第三代头孢菌素加氨苄西林或哌拉西林 - 他唑巴坦来预防感染。终末期肝病模型（MELD）评分高的患者肝移植后感染风险增加。然而，碳青霉烯类药物能否用于这些高危患者的手术预防尚不清楚。因此，本研究旨在比较碳青霉烯类药物与头孢菌素或哌拉西林 - 他唑巴坦在MELD评分≥30的高危肝移植受者手术预防中的有效性。
这项回顾性研究纳入了2018年5月至2020年9月期间接受肝移植且MELD评分≥30的成年患者。我们比较分析了使用头孢哌酮 - 舒巴坦或哌拉西林 - 他唑巴坦与使用碳青霉烯类药物进行手术预防的患者之间的感染率和结局。
本研究纳入了105例肝移植受者。分别有78例和27例患者使用非碳青霉烯类和碳青霉烯类抗生素进行手术预防。30天内相应的感染发生率分别为38.5%和66.7%（p = 0.011）。多因素分析显示，再次手术和Child-Pugh评分是肝移植后30天内感染的独立危险因素。以下四个危险因素与肝移植后180天的生存率相关：MELD评分、血管并发症、腹腔内出血以及耐碳青霉烯类菌（CRO）感染。碳青霉烯类药物组和非碳青霉烯类药物组的CRO感染发生率无显著差异（18.5%对11.5%；p = 0.345）。
使用碳青霉烯类药物进行手术预防与肝移植后30天内的感染发生率、肝移植后180天的生存率或CRO感染无关。因此，对于MELD评分≥30的肝移植受者，碳青霉烯类药物在围手术期抗生素预防方面并不优于头孢菌素或哌拉西林 - 他唑巴坦。
