Arnow P M
University of Chicago, Department of Medicine, IL 60637, USA.
Infect Dis Clin North Am. 1995 Dec;9(4):849-62.
Bacterial infections during the first month after liver transplantation remain a serious problem despite perioperative administration of systemic broad-spectrum antibiotics. These infections usually have been caused by aerobic gram-negative bacilli from the alimentary tract, and the most promising approach during the past decade is to eliminate or suppress these organisms by SBD. Several centers that have used SBD for prophylaxis have reported favorable results, but only one of the studies has been prospective and randomized. Based on the limited information now available, it seems that the efficacy of SBD is dependent on eliminating or suppressing aerobic gram-negative bacilli by the time of transplant surgery. This is an especially important point because successful SBD requires at least several days of treatment, and there are practical problems initiating and maintaining SBD in advance of unscheduled cadaver liver transplantation. Key areas for investigation are to establish by appropriately designed studies the efficacy of SBD and to examine the importance of achieving SBD prior to transplantation surgery.
尽管在肝移植围手术期使用了全身性广谱抗生素，但肝移植后第一个月内的细菌感染仍然是一个严重问题。这些感染通常由来自消化道的需氧革兰氏阴性杆菌引起，在过去十年中最有前景的方法是通过选择性肠道去污（SBD）消除或抑制这些微生物。几个使用SBD进行预防的中心报告了良好的结果，但只有一项研究是前瞻性和随机的。根据目前有限的信息，似乎SBD的疗效取决于在移植手术时消除或抑制需氧革兰氏阴性杆菌。这是一个特别重要的点，因为成功的SBD需要至少几天的治疗，并且在计划外的尸体肝移植之前启动和维持SBD存在实际问题。关键的研究领域是通过适当设计的研究确定SBD的疗效，并检查在移植手术前实现SBD的重要性。
