Nursing Department, Third Xiangya Hospital, Central South University, Changsha 410013.
Xiangya School of Nursing, Central South University, Changsha 410013.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2023 May 28;48(5):707-715. doi: 10.11817/j.issn.1672-7347.2023.220631.
Gram-positive cocci is the main pathogen responsible for early infection after liver transplantation (LT), posing a huge threat to the prognosis of liver transplant recipients. This study aims to analyze the distribution and drug resistance of Gram-positive cocci, the risk factors for infections and efficacy of antibiotics within 2 months after LT, and to guide the prevention and treatment of these infections.
In this study, data of pathogenic bacteria distribution, drug resistance and therapeutic efficacy were collected from 39 Gram-positive cocci infections among 256 patients who received liver transplantation from donation after citizens' death in the Third Xiangya Hospital of Central South University from January 2019 to July 2022, and risk factors for Gram-positive cocci infection were analyzed.
was the dominant pathogenic bacteria (33/51, 64.7%), followed by (11/51, 21.6%). The most common sites of infection were abdominal cavity/biliary tract (13/256, 5.1%) and urinary tract (10/256, 3.9%). Fifty (98%) of the 51 Gram-positive cocci infections occurred within 1 month after LT. The most sensitive drugs to Gram-positive cocci were teicoplanin, tigecycline, linezolid and vancomycin. Vancomycin was not used in all patients, considering its nephrotoxicity. Vancomycin was not administered to all patients in view of its nephrotoxicity.There was no significant difference between the efficacy of daptomycin and teicoplanin in the prevention of cocci infection (>0.05). Univariate analysis indicated that preoperative Model for End-Stage Liver Disease (MELD) score >25 (=0.005), intraoperative red blood cell infusion ≥12 U (=0.013) and exposure to more than 2 intravenous antibiotics post-LT (=0.003) were related to Gram-positive cocci infections. Multivariate logistic regression analysis revealed that preoperative MELD score >25 (=2.378, 95% 1.124 to 5.032, =0.024) and intraoperative red blood cell transfusion ≥ 12 U (=2.757, 95% 1.227 to 6.195, =0.014) were independent risk factors for Gram-positive cocci infections after LT. Postoperative Gram-positive cocci infections were reduced in LT recipients exposing to more than two intravenous antibiotics post-LT (=0.269, 95% 0.121 to 0.598, =0.001).
Gram-positive cocci infections occurring early after liver transplantation were dominated by infections at the abdominal/biliary tract and urinary tract. Teicoplanin, tigecycline and linezolid were anti-cocci sensitive drugs. Daptomycin and teicoplanin were equally effective in preventing cocci infections due to Gram-positive cocci. Patients with high preoperative MELD score and massive intraoperative red blood cell transfusion were more likely to suffer Gram-positive cocci infection after surgery. Postoperative Gram-positive cocci infections were reduced in recipients exposing to more than two intravenous antibiotics post-LT.
革兰阳性球菌是肝移植（LT）后早期感染的主要病原体，对肝移植受者的预后构成巨大威胁。本研究旨在分析革兰阳性球菌的分布和耐药性、LT 后 2 个月内感染的危险因素以及抗生素的疗效，以指导这些感染的预防和治疗。
本研究收集了 2019 年 1 月至 2022 年 7 月中南大学湘雅三医院公民逝世后供体来源的 256 例 LT 患者中 39 例革兰阳性球菌感染的病原菌分布、耐药性和治疗效果数据，并分析革兰阳性球菌感染的危险因素。
表皮葡萄球菌（33/51，64.7%）是主要的致病菌，其次是金黄色葡萄球菌（11/51，21.6%）。感染最常见的部位是腹腔/胆道（13/256，5.1%）和泌尿道（10/256，3.9%）。51 例革兰阳性球菌感染中，50 例（98%）发生在 LT 后 1 个月内。革兰阳性球菌最敏感的药物是替考拉宁、替加环素、利奈唑胺和万古霉素。由于其肾毒性，并未在所有患者中使用万古霉素。考虑到其肾毒性，并未在所有患者中使用万古霉素。达托霉素和替考拉宁预防球菌感染的疗效无显著差异（>0.05）。单因素分析表明，术前终末期肝病模型（MELD）评分>25（=0.005）、术中红细胞输注≥12 U（=0.013）和 LT 后使用>2 种静脉抗生素（=0.003）与革兰阳性球菌感染有关。多因素 logistic 回归分析显示，术前 MELD 评分>25（=2.378，95%CI 1.124-5.032，=0.024）和术中红细胞输注≥12 U（=2.757，95%CI 1.227-6.195，=0.014）是 LT 后革兰阳性球菌感染的独立危险因素。LT 后使用>2 种静脉抗生素的患者术后革兰阳性球菌感染减少（=0.269，95%CI 0.121-0.598，=0.001）。
LT 后早期发生的革兰阳性球菌感染以腹腔/胆道和泌尿道的金黄色葡萄球菌感染为主。替考拉宁、替加环素和利奈唑胺是抗球菌敏感药物。达托霉素和替考拉宁预防革兰阳性球菌感染的疗效相当。术前 MELD 评分高和术中大量输血的患者术后更易发生革兰阳性球菌感染。LT 后使用>2 种静脉抗生素可减少革兰阳性球菌感染。
