Steffen R, Reinhartz O, Blumhardt G, Bechstein W O, Raakow R, Langrehr J M, Rossaint R, Slama K, Neuhaus P
Abteilung für Chirurgie, Freie Universität Berlin, Rudolf Virchow Klinik, Germany.
Transpl Int. 1994;7(2):101-8. doi: 10.1007/BF00336470.
Bacterial and fungal infections are a major cause of morbidity and mortality after orthotopic liver transplantation. In the immunocompromised host, infections are thought to arise from the gut, which is almost always colonized with potential pathogens. Using oral selective bowel decontamination (SBD), potential pathogens can be eradicated from the gut and infections prevented. In this catamnestic study we have reviewed gastrointestinal colonization, bacterial and fungal infections, and bacterial resistance to standard antibiotics in our first 206 liver transplant patients while under SBD. With few exceptions, gram-negatives were eradicated from the gastrointestinal tract and secondary colonization was inhibited. In spite of unsatisfactory elimination of Candida, probably because nystatin doses were too low, Candida infections were rare (n = 4) and none was fatal. One and two-year survival rates were 93% and 92%, respectively. The bacterial and fungal infection rate was 27.8% with an infection-related mortality of 1.95%. Infections with aerobic gram-positive bacteria prevailed and only 11 gram-negative and 11 fungal infections occurred; among the latter, Aspergillus and Mucor were the most serious and responsible for three of the six deaths in this series. With regard to the development of resistance, we found an increasing number of enterococci and coagulase-negative staphylococci resistant to ciprofloxacin and imipenem, respectively, but unlikely as a consequence of SBD.
细菌和真菌感染是原位肝移植后发病和死亡的主要原因。在免疫功能低下的宿主中，感染被认为源于肠道，肠道几乎总是定植有潜在病原体。通过口服选择性肠道去污（SBD），可以从肠道根除潜在病原体并预防感染。在这项回顾性研究中，我们回顾了我们的前206例肝移植患者在接受SBD期间的胃肠道定植、细菌和真菌感染以及细菌对标准抗生素的耐药性。除少数例外，革兰氏阴性菌从胃肠道被根除，继发性定植受到抑制。尽管念珠菌的清除效果不尽人意，可能是因为制霉菌素剂量过低，但念珠菌感染很少见（n = 4），且无致命病例。1年和2年生存率分别为93%和92%。细菌和真菌感染率为27.8%，感染相关死亡率为1.95%。需氧革兰氏阳性菌感染最为常见，仅发生11例革兰氏阴性菌感染和11例真菌感染；在后者中，曲霉和毛霉最为严重，是该系列6例死亡病例中的3例的病因。关于耐药性的发展，我们发现分别对环丙沙星和亚胺培南耐药的肠球菌和凝固酶阴性葡萄球菌数量不断增加，但不太可能是SBD的结果。
