Carugati Manuela, Arif Sana, Yarrington Michael E, King Lindsay Y, Harris Matt, Evans Kyla, Barbas Andrew S, Sudan Debra L, Miller Rachel A, Alexander Barbara D
Department of Medicine, Division of Infectious Diseases, Duke University, Durham, NC.
Department of Medicine, Division of Gastroenterology, Duke University, Durham, NC.
Transplant Direct. 2024 Nov 14;10(12):e1719. doi: 10.1097/TXD.0000000000001719. eCollection 2024 Dec.
Invasive primary surgical site infections (IP-SSI) are a severe complication of liver transplant surgery. Identification of risk factors for IP-SSI is critical to IP-SSI prevention.
All adult single liver transplants performed at Duke University Hospital in the period 2015-2020 were reviewed for IP-SSI occurring within 90 d of transplant. Risks for IP-SSI were identified using least absolute shrinkage and selection operator variable selection procedure. A 2-sided value of <0.05 was considered statistically significant.
IP-SSI were identified in 34/470 (7.2%) adult single liver transplants. Repeat transplantation, spilt liver, Roux-en-Y biliary anastomosis, anastomotic leak, and post-transplant renal replacement therapy were positively associated with IP-SSI. IP-SSI were associated with increased length of index transplant hospitalization (24.5 versus 10.0 d, < 0.01) and 1-y all-cause mortality (14.7% versus 4.1%, = 0.02). Gram positive bacteria were the main pathogens (51.7%), followed by Gram negative bacteria (24.1%) and (24.1%). Multidrug resistance bacteria increased over time (27.3% in 2015 versus 66.7% in 2020, = 0.17).
In the setting of routine antimicrobial prophylaxis and an overall low rate of IP-SSI, surgical factors were the main determinants of IP-SSI among adult liver transplant recipients. IP-SSI had a negative impact on the length of index transplant hospitalization and 1-y mortality. While the surgical factors associated with an increased risk of IP-SSI are not easily modifiable, their impact may be best contained by close clinical monitoring and tailored antimicrobial therapy.
侵袭性原发性手术部位感染（IP-SSI）是肝移植手术的严重并发症。识别IP-SSI的危险因素对于预防IP-SSI至关重要。
回顾2015年至2020年期间在杜克大学医院进行的所有成人单肝移植手术，以确定移植后90天内发生的IP-SSI。使用最小绝对收缩和选择算子变量选择程序识别IP-SSI的危险因素。双侧P值<0.05被认为具有统计学意义。
在470例成人单肝移植中有34例（7.2%）发生了IP-SSI。再次移植、劈离式肝移植、Roux-en-Y胆肠吻合术、吻合口漏和移植后肾脏替代治疗与IP-SSI呈正相关。IP-SSI与首次移植住院时间延长相关（24.5天对10.0天，P<0.01）以及1年全因死亡率增加相关（14.7%对4.1%，P=0.02）。革兰氏阳性菌是主要病原体（51.7%），其次是革兰氏阴性菌（24.1%）和真菌（24.1%）。多重耐药菌随时间增加（2015年为27.3%，2020年为66.7%，P=0.17）。
在常规抗菌预防和IP-SSI总体发生率较低的情况下，手术因素是成人肝移植受者中IP-SSI的主要决定因素。IP-SSI对首次移植住院时间和1年死亡率有负面影响。虽然与IP-SSI风险增加相关的手术因素不易改变，但通过密切的临床监测和针对性的抗菌治疗可能最好地控制其影响。
