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肝移植术后多重耐药菌感染危险因素的单中心临床研究

方翊天 吴若林 黄帆 王国斌 冯丽娟 余孝俊 侯刘进 叶征辉 耿小平 赵红川

方翊天, 吴若林, 黄帆, 等. 肝移植术后多重耐药菌感染危险因素的单中心临床研究[J]. 器官移植, 2021, 12(2): 197-202. doi: 10.3969/j.issn.1674-7445.2021.02.010
引用本文: 方翊天, 吴若林, 黄帆, 等. 肝移植术后多重耐药菌感染危险因素的单中心临床研究[J]. 器官移植, 2021, 12(2): 197-202. doi: 10.3969/j.issn.1674-7445.2021.02.010
Fang Yitian, Wu Ruolin, Huang Fan, et al. Risk factors of multi-drug resistant organism infection after liver transplantation: a single-center clinical trial[J]. ORGAN TRANSPLANTATION, 2021, 12(2): 197-202. doi: 10.3969/j.issn.1674-7445.2021.02.010
Citation: Fang Yitian, Wu Ruolin, Huang Fan, et al. Risk factors of multi-drug resistant organism infection after liver transplantation: a single-center clinical trial[J]. ORGAN TRANSPLANTATION, 2021, 12(2): 197-202. doi: 10.3969/j.issn.1674-7445.2021.02.010

肝移植术后多重耐药菌感染危险因素的单中心临床研究

doi: 10.3969/j.issn.1674-7445.2021.02.010
基金项目: 

安徽高校自然科学研究重点项目 2019xkjT022

详细信息
    作者简介:

    方翊天,男,1995年生,硕士,住院医师,研究方向为器官移植,Email:fangytroy@hotmail.com

    通讯作者:

    赵红川,男,1969年生,博士,主任医师,研究方向为器官移植,Email:zhc0117@sina.com

  • 中图分类号: R617, R37

Risk factors of multi-drug resistant organism infection after liver transplantation: a single-center clinical trial

More Information
  • 摘要:   目的  分析肝移植术后发生多重耐药菌(MDRO)感染的危险因素。  方法  回顾性分析77例肝移植受者的临床资料,根据是否发生MDRO感染分为非MDRO感染组(51例)及MDRO感染组(26例)。总结肝移植受者术后MDRO的感染率和菌株分布情况;分析肝移植受者术后发生MDRO感染的危险因素;比较两组受者的预后情况。  结果  肝移植术后MDRO感染率为34%(26/77),主要为耐碳青霉烯类MDRO感染,主要感染部位为肺部、腹腔和切口。单因素分析提示术后气管插管≥48 h、重症监护室(ICU)入住时间≥72 h、住院时间≥30 d、再次手术、持续性肾脏替代治疗(CRRT)和他克莫司(Tac)血药浓度≥15 ng/mL是肝移植术后发生MDRO感染的危险因素。Cox回归分析提示术后气管插管≥48 h、再次手术、CRRT和Tac血药浓度≥15 ng/mL是肝移植术后发生MDRO感染的独立危险因素。MDRO感染组病死率高于非MDRO感染组[31%(8/26)比10%(5/51),P=0.01]。  结论  术后气管插管≥48 h、再次手术、CRRT和Tac血药浓度≥15 ng/mL会增加肝移植术后MDRO感染的风险,影响受者的预后。
  • 图  1  两组肝移植受者术后生存曲线

    Figure  1.  Survival curves of liver transplant recipients in two groups

    表  1  肝移植术后发生MDRO感染危险因素的单因素分析

    Table  1.   Univariate analysis of risk factors for MDRO infection after liver transplantation [n(%)]

    变量 非MDRO感染组(n=51) MDRO感染组(n=26) χ2 P
    术前指标
      年龄≥55岁 13(25) 4(15) 0.198 0.657
      性别 0.127 0.722
        男 40(78) 21(81)
        女 11(22) 5(19)
      原发病
        乙肝肝硬化失代偿 26(51) 10(38) 1.084 0.298
        肝细胞癌 10(20) 4(15) 0.020 0.887
        终末期良性胆道病 9(18) 5(19) < 0.001 1.000
        其他 6(12) 7(27) 1.843 0.175
      MELD/PELD评分≥25分 15(29) 9(35) 0.983 0.322
      Child-Pugh C级 27(53) 18(69) 0.316 0.574
      住院时间≥30 d 7(14) 9(35) 1.073 0.300
      合并感染 5(10) 6(23) 2.121 0.145
      供者来源性感染 8(16) 5(19) 3.054 0.081
    术中指标
      手术时间≥8 h 22(43) 11(42) 0.062 0.803
      无肝期≥60 min 30(59) 11(42) 3.357 0.067
      失血量≥2 L 14(27) 9(35) 0.002 0.961
      输血量≥8 U 20(39) 12(46) 0.009 0.923
    术后指标
      气管插管≥48 h 9(18) 15(58) 15.831 < 0.001
      ICU入住时间≥72 h 15(29) 16(62) 4.618 0.032
      住院时间≥30 d 13(25) 18(69) 5.228 0.022
      再次手术 1(2) 6(23) 9.505 0.002
      CRRT 4(8) 7(27) 11.868 0.001
      胆道并发症 4(8) 5(19) 0.738 0.390
      Tac血药浓度≥15 ng/ mL 7(14) 9(35) 5.911 0.015
      血红蛋白≥60 g/L 4(8) 5(19) 1.029 0.310
      白蛋白≥35 g/L 15(29) 10(38) 1.328 0.249
    下载: 导出CSV

    表  2  肝移植术后发生MDRO感染危险因素的Cox回归分析

    Table  2.   Cox regression analysis of risk factors for MDRO infection after liver transplantation

    变量 β SE OR 95%CI P
    气管插管≥48 h 0.956 0.460 2.601 1.055~6.413 0.038
    再次手术 1.666 0.523 5.292 1.898~14.759 0.001
    CRRT 1.453 0.556 4.276 1.438~12.716 0.009
    Tac血药浓度≥15 ng/mL 1.459 0.473 4.302 1.701~10.882 0.002
    注:①SE为标准误。
    OR为比值比。
    CI为可信区间。
    下载: 导出CSV
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  • 收稿日期:  2020-10-25
  • 网络出版日期:  2021-03-19
  • 刊出日期:  2021-03-15

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