Liu Lei, Jiang Zhongyi, Liao Huanjin, Xu Zhiwei, Yu Yang, Zhong Lin, Wang Pusen
Department of General Surgery, Shanghai General Hospital of Nanjing Medical University, Shanghai, China.
Department of Liver Surgery and Organ Transplantation Center, Shenzhen Third People's Hospital, Second Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China.
Microbiol Spectr. 2025 Jul;13(7):e0071125. doi: 10.1128/spectrum.00711-25. Epub 2025 Jun 10.
Liver transplantation (LT) recipients exhibit heightened susceptibility to infection and sepsis, which have emerged as the most prevalent and life-threatening complications significantly impacting prognosis. The etiological spectrum of organisms following LT has undergone substantial changes over recent decades. This retrospective monocentric study included a consecutive cohort of 776 LT patients from 2010 to 2023. A total of 207 pathogens were isolated from 180 infection sites of 156 (20.1%) patients, comprising 82 (39.6%) gram-positive bacteria, 90 (43.5%) gram-negative bacteria, and 35 (16.9%) fungi. Among the gram-negative bacteria, carbapenem-resistant (CRE) was found in eight cases (seven and one ), extended-spectrum beta-lactamases (ESBLs)-producing bacteria were detected in seven cases (five and two ), and carbapenem-resistant (CRAB) was found in 14 cases and 2 cases had carbapenem-resistant (CRPA). Advanced age, prolonged mechanical ventilation, and extended ICU stay were significantly associated with increased susceptibility to post-LT infections. Infected patients with bilirubin levels exceeding 90 µmol/L (OR 3.46, 95% CI 1.46-8.24; = 0.005) as well as drug-resistant bacterial infections (OR 2.35, 95% CI 1.07-5.15; = 0.033) were more likely to develop sepsis. More than 45% of bacterial infections were caused by drug-resistant pathogens, with over 30% of gram-negative bacteria exhibiting carbapenem resistance. In conclusion, the implementation of strategies aimed at reducing the duration of mechanical ventilation and ICU stay may effectively decrease the incidence of post-liver transplantation infection. Furthermore, pre-transplant interventions targeting reduction in jaundice could potentially mitigate the risk of post-transplant sepsis.IMPORTANCEThis study elucidates the recent pathogen spectrum associated with infections in liver transplantation and compares it with the pathogen spectrum from previous periods. Additionally, it analyzes high-risk factors for post-transplant infections and innovatively examines the risk factors that contribute to the progression from infection to severe infection and sepsis. Based on these findings, potential intervention strategies targeting infection and sepsis are proposed.
肝移植（LT）受者对感染和脓毒症的易感性增强，这些已成为最常见且危及生命的并发症，对预后有重大影响。近几十年来，肝移植后感染的病原体谱发生了显著变化。这项回顾性单中心研究纳入了2010年至2023年连续的776例肝移植患者队列。共从156例（20.1%）患者的180个感染部位分离出207种病原体，包括82种（39.6%）革兰氏阳性菌、90种（43.5%）革兰氏阴性菌和35种（16.9%）真菌。在革兰氏阴性菌中，发现8例（7例肺炎克雷伯菌和1例大肠埃希菌）耐碳青霉烯类（CRE），7例（5例肺炎克雷伯菌和2例大肠埃希菌）检测到产超广谱β-内酰胺酶（ESBLs）细菌，14例发现耐碳青霉烯类鲍曼不动杆菌（CRAB），2例有耐碳青霉烯类铜绿假单胞菌（CRPA）。高龄、长时间机械通气和延长的重症监护病房（ICU）住院时间与肝移植后感染易感性增加显著相关。胆红素水平超过90 µmol/L的感染患者（比值比[OR] 3.46，95%置信区间[CI] 1.46 - 8.24；P = 0.005）以及耐药菌感染患者（OR 2.35，95% CI 1.07 - 5.15；P = 0.033）更易发生脓毒症。超过 45%的细菌感染由耐药病原体引起，超过30%的革兰氏阴性菌表现出碳青霉烯耐药。总之，实施旨在缩短机械通气和ICU住院时间的策略可能有效降低肝移植后感染的发生率。此外，针对降低黄疸的移植前干预措施可能会降低移植后脓毒症的风险。重要性本研究阐明了肝移植中与感染相关的近期病原体谱，并将其与既往时期的病原体谱进行比较。此外，分析了移植后感染的高危因素，并创新性地研究了导致从感染进展为严重感染和脓毒症的危险因素。基于这些发现，提出了针对感染和脓毒症的潜在干预策略。
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