Gladdy R A, Richardson S E, Davies H D, Superina R A
Department of General Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
Liver Transpl Surg. 1999 Jan;5(1):16-24. doi: 10.1002/lt.500050105.
A retrospective review of 100 liver transplantations in 98 children was performed to determine the incidence of infection caused by Candida organism in these patients and to identify risk factors that may predispose to serious fungal infection. Thirty-one infections caused by Candida organisms developed during the initial 28 days posttransplantation: 19 were definite invasive infections (one deep site or one positive blood culture), 2 were probable invasive infections (three superficial sites), and 10 were urinary tract infections. Eleven of 19 patients had fungemia or a disseminated infection (two noncontiguous deep organs involved and/or positive blood cultures) and 8 of 19 had peritoneal candidiasis. Infection caused by Candida organisms was a contributing factor to mortality in 7 of 21 patients (case fatality rate of 33%) with invasive infection. Risk factors that were predictive for invasive infection by univariate analysis included the following: pretransplantation antibiotic therapy, length of transplant operation, transfusion requirement, number of days in the intensive care unit, number of days intubated, number of concurrent bacterial infections, number of antibiotics administered, number of laparotomies performed posttransplantation, retransplantation, hepatic artery thrombosis, bile leaks, and renal and respiratory failure. By logistic regression analysis, bile leak, hepatic artery thrombosis, preoperative steroid use, transfusion requirement, and the number of days intubated were identified as independent risk factors for invasive infection caused by Candida organisms. The use of prophylactic antifungal agents in high-risk patients may be important in reducing the serious morbidity and mortality associated with sepsis caused by Candida organisms in pediatric liver transplant recipients.
对98名儿童的100例肝移植进行回顾性研究，以确定这些患者中念珠菌属感染的发生率，并识别可能易引发严重真菌感染的危险因素。移植后最初28天内发生了31例由念珠菌属引起的感染：19例为确诊的侵袭性感染（一个深部部位或一次血培养阳性），2例为可能的侵袭性感染（三个浅表部位），10例为尿路感染。19例患者中有11例发生真菌血症或播散性感染（累及两个不相邻的深部器官和/或血培养阳性），19例中有8例发生腹膜念珠菌病。念珠菌属感染是21例侵袭性感染患者中7例死亡的一个促成因素（病死率为33%）。单因素分析中预测侵袭性感染的危险因素包括：移植前抗生素治疗、移植手术时间、输血需求、重症监护病房天数、插管天数、并发细菌感染数量、使用抗生素数量、移植后剖腹手术次数、再次移植、肝动脉血栓形成、胆漏以及肾和呼吸衰竭。通过逻辑回归分析，胆漏、肝动脉血栓形成、术前使用类固醇、输血需求和插管天数被确定为念珠菌属引起侵袭性感染的独立危险因素。在高危患者中使用预防性抗真菌药物对于降低小儿肝移植受者念珠菌属败血症相关的严重发病率和死亡率可能很重要。
