肝移植术后感染：病原体的耐药性与分布、危险因素及对预后的影响

infections after liver transplantation: Drug resistance and distribution of pathogens, risk factors, and influence on outcomes.

作者信息

Guo Long, Peng Peng, Peng Wei-Ting, Zhao Jie, Wan Qi-Quan

机构信息

Department of Respiratory and Critical Care Medicine, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China.

Clinical Laboratory Medicine Center, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou 421007, Hunan Province, China.

出版信息

World J Hepatol. 2024 Apr 27;16(4):612-624. doi: 10.4254/wjh.v16.i4.612.

DOI:10.4254/wjh.v16.i4.612

PMID:38689752

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11056902/

Abstract

BACKGROUND

Liver transplantation (LT) is the only curative treatment for end-stage liver disease. However, LT recipients are susceptible to infection, which is the leading cause of early mortality after LT. infections (KPIs) in the bloodstream are common in LT recipients. We hypothesized that KPIs and carbapenem-resistant (CRKP) infections may affect the outcomes of LT recipients.

AIM

To assess KPI incidence, timing, distribution, drug resistance, and risk factors following LT and its association with outcomes.

METHODS

This retrospective study included 406 patients undergoing LT at The Third Xiangya Hospital of Central South University, a tertiary hospital, from January 2015 to January 2023. We investigated the risk factors for KPIs and assessed the impact of KPIs and CRKP infections on the prognosis of LT recipients using logistic regression analysis.

RESULTS

KPI incidence was 7.9% ( = 32), with lung/thoracic cavity the most frequent site of infection; the median time from LT to KPI onset was 7.5 d. Of 44 isolates, 43 (97.7%) and 34 (77.3%) were susceptible to polymyxin B or ceftazidime/avibactam and tigecycline, respectively; > 70% were resistant to piperacillin/ tazobactam, ceftazidime, cefepime, aztreonam, meropenem, and levofloxacin. Female sex [odds ratio (OR) = 2.827, 95% confidence interval (CI): 1.256-6.364; = 0.012], pre-LT diabetes (OR = 2.794, 95%CI: 1.070-7.294; = 0.036), day 1 post-LT alanine aminotransferase (ALT) levels ≥ 1500 U/L (OR = 3.645, 95%CI: 1.671-7.950; = 0.001), and post-LT urethral catheter duration over 4 d (OR = 2.266, 95%CI: 1.016-5.054; = 0.046) were risk factors for KPI. CRKP infections, but not KPIs, were risk factors for 6-month all-cause mortality post-LT.

CONCLUSION

KPIs occur frequently and rapidly after LT. Risk factors include female sex, pre-LT diabetes, increased post-LT ALT levels, and urethral catheter duration. CRKP infections, and not KPIs, affect mortality.

摘要

背景

肝移植（LT）是终末期肝病的唯一治愈性治疗方法。然而，LT受者易发生感染，这是LT后早期死亡的主要原因。血流中关键病原菌感染（KPIs）在LT受者中很常见。我们推测KPIs和耐碳青霉烯类肺炎克雷伯菌（CRKP）感染可能影响LT受者的预后。

目的

评估LT后KPI的发生率、发生时间、分布、耐药性及危险因素，以及其与预后的关联。

方法

这项回顾性研究纳入了2015年1月至2023年1月在中南大学湘雅三医院（一家三级医院）接受LT的406例患者。我们调查了KPIs的危险因素，并使用逻辑回归分析评估KPIs和CRKP感染对LT受者预后的影响。

结果

KPI发生率为7.9%（n = 32），肺部/胸腔是最常见的感染部位；从LT到KPI发病的中位时间为7.5天。在44株分离菌中，43株（97.7%）和34株（77.3%）分别对多粘菌素B或头孢他啶/阿维巴坦以及替加环素敏感；超过70%的菌株对哌拉西林/他唑巴坦、头孢他啶、头孢吡肟、氨曲南、美罗培南和左氧氟沙星耐药。女性[比值比（OR）= 2.827，95%置信区间（CI）：1.256 - 6.364；P = 0.012]、LT前糖尿病（OR = 2.794，95%CI：1.070 - 7.294；P = 0.036）、LT后第1天丙氨酸氨基转移酶（ALT）水平≥1500 U/L（OR = 3.645，95%CI：1.671 - 7.950；P = 0.001）以及LT后尿道导管留置时间超过4天（OR = 2.266，95%CI：1.016 - 5.054；P = 0.046）是KPI的危险因素。CRKP感染而非KPIs是LT后6个月全因死亡的危险因素。