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菌血症与肺移植术后重症监护病房死亡率增加相关。

Bacteraemia Is Associated with Increased ICU Mortality in the Postoperative Course of Lung Transplantation.

作者信息

Tran-Dinh Alexy, Guiot Marion, Tanaka Sébastien, Lortat-Jacob Brice, Atchade Enora, Zappella Nathalie, Mordant Pierre, Castier Yves, Mal Hervé, Weisenburger Gaelle, Messika Jonathan, Grall Nathalie, Montravers Philippe

机构信息

Département d'Anesthésie-Réanimation, Hôpital Bichat Claude Bernard, AP-HP, Université Paris Cité, 75018 Paris, France.

INSERM UMR 1148 LVTS, Université Paris Cité, 75018 Paris, France.

出版信息

Antibiotics (Basel). 2022 Oct 13;11(10):1405. doi: 10.3390/antibiotics11101405.

Abstract

We aimed to describe the prevalence, risk factors, morbidity and mortality associated with the occurrence of bacteraemia during the postoperative ICU stay after lung transplantation (LT). We conducted a retrospective single-centre study that included all consecutive patients who underwent LT between January 2015 and October 2021. We analysed all the blood cultures drawn during the postoperative ICU stay, as well as samples from suspected infectious sources in case of bacteraemia. Forty-six bacteria were isolated from 45 bacteraemic patients in 33/303 (10.9%) patients during the postoperative ICU stay. (17.8%) was the most frequent bacteria, followed by (15.6%) and (15.6%). Multidrug-resistant bacteria accounted for 8/46 (17.8%) of the isolates. The most common source of bacteraemia was pneumonia (38.3%). No pre- or intraoperative risk factor for bacteraemia was identified. Recipients who experienced bacteraemia required more renal replacement therapy, invasive mechanical ventilation, norepinephrine support, tracheotomy and more days of hospitalization during the ICU stay. After adjustment for age, sex, type of LT procedure and the need for intraoperative ECMO, the occurrence of bacteraemia was associated with a higher mortality rate in the ICU (aOR = 3.55, 95% CI [1.56-8.08], = 0.003). Bacteraemia is a major source of concern for lung transplant recipients.

摘要

我们旨在描述肺移植(LT)术后重症监护病房(ICU)住院期间菌血症发生的患病率、危险因素、发病率和死亡率。我们进行了一项回顾性单中心研究,纳入了2015年1月至2021年10月期间所有连续接受LT的患者。我们分析了术后ICU住院期间采集的所有血培养样本,以及菌血症时疑似感染源的样本。在术后ICU住院期间,303例患者中有33例(10.9%)的45例菌血症患者分离出46种细菌。(17.8%)是最常见的细菌,其次是(15.6%)和(15.6%)。多重耐药菌占分离株的8/46(17.8%)。菌血症最常见的来源是肺炎(38.3%)。未发现菌血症的术前或术中危险因素。发生菌血症的受者在ICU住院期间需要更多的肾脏替代治疗、有创机械通气、去甲肾上腺素支持、气管切开术以及更长的住院天数。在调整年龄、性别、LT手术类型和术中体外膜肺氧合(ECMO)需求后,菌血症的发生与ICU更高的死亡率相关(调整后比值比[aOR]=3.55,95%置信区间[CI][1.56 - 8.08],P = 0.003)。菌血症是肺移植受者主要关注的问题。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/18f8/9598225/dbc63e00ac78/antibiotics-11-01405-g001.jpg

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Bloodstream infections after solid-organ transplantation.实体器官移植后的血流感染。
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