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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
  • [1] STARZL TE. The long reach of liver transplantation[J]. Nat Med, 2012, 18(10): 1489-1492. DOI: 10.1038/nm.2927.
    [2] 郑树森, 俞军, 张武. 肝移植在中国的发展现状[J]. 临床肝胆病杂志, 2014, 30(1): 2-4. DOI: 10.3969/j.issn. 1001-5256.2014.01.001.

    ZHENG SS, YU J, ZHANG W. Current development of liver transplantation in China[J]. J Clin Hepatol, 2014, 30(1): 2-4. DOI: 10.3969/j.issn.1001-5256.2014.01.001.
    [3] SHAFIEKHANI M, MIRJALILI M, VAZIN A. Prevalence, risk factors and treatment of the most common Gram-negative bacterial infections in liver transplant recipients: a review[J]. Infect Drug Resist, 2019, 12: 3485-3495. DOI: 10.2147/IDR.S226217.
    [4] 林栋栋, 刘晋宁. 肝移植围术期感染的处理[J]. 北京医学, 2017, 39(9): 895-896. DOI: 10.15932/j.0253-9713. 2017.09.001.

    LIN DD, LIU JN. Management of perioperative infection in liver transplantation[J]. Beijing Med J, 2017, 39(9): 895-896. DOI: 10.15932/j.0253-9713.2017.09.001.
    [5] IDOSSA DW, SIMONETTO DA. Infectious complications and malignancies arising after liver transplantation[J]. Anesthesiol Clin, 2017, 35(3): 381-393. DOI: 10.1016/j.anclin.2017.04.002.
    [6] SANTORO-LOPES G, DE GOUVÊA EF. Multidrug-resistant bacterial infections after liver transplantation: an ever-growing challenge[J]. World J Gastroenterol, 2014, 20(20): 6201-6210. DOI: 10.3748/wjg.v20.i20.6201.
    [7] KALPOE JS, SONNENBERG E, FACTOR SH, et al. Mortality associated with carbapenem-resistant klebsiella pneumoniae infections in liver transplant recipients[J]. Liver Transpl, 2012, 18(4): 468-474. DOI: 10.1002/lt.23374.
    [8] AGUADO JM, SILVA JT, FERNÁNDEZ-RUIZ M, et al. Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations[J]. Transplant Rev (Orlando), 2018, 32(1): 36-57. DOI: 10.1016/j.trre.2017.07.001.
    [9] TU Z, XIANG P, XU X, et al. DCD liver transplant infection: experience from a single centre in China[J]. Int J Clin Pract, 2016, 70(Suppl 185): 3-10. DOI10.1111/ijcp.12810. doi: 10.1111/ijcp.12810
    [10] 姚兴伟, 林英, 杨琦, 等. 248株碳青霉烯类耐药肠杆菌科细菌临床特点及耐药性分析[J]. 中国实验诊断学, 2020, 24(2): 320-322.

    YAO XW, LIN Y, YANG Q, et al. Analysis on clinical characteristics and drug resistance in 248 strains of carbapenems-resistant enterobacteriaceae bacteria[J]. Chin J Lab Diagn, 2020, 24(2): 320-322.
    [11] OLSON JC, KARVELLAS CJ. Critical care management of the patient with cirrhosis awaiting liver transplant in the intensive care unit[J]. Liver Transpl, 2017, 23(11): 1465-1476. DOI: 10.1002/lt.24815.
    [12] GHANSHANI R, GUPTA R, GUPTA BS, et al. Epidemiological study of prevalence, determinants, and outcomes of infections in medical ICU at a tertiary care hospital in India[J]. Lung India, 2015, 32(5): 441-448. DOI: 10.4103/0970-2113.164155.
    [13] LEWIS JD, BARROS AJ, SIFRI CD. Comparison of risk factors and outcomes of daptomycin-susceptible and -nonsusceptible vancomycin-resistant enterococcus faecium infections in liver transplant recipients[J]. Transpl Infect Dis, 2018, 20(3): e12856. DOI: 10.1111/tid.12856.
    [14] TAKEDA K, TANAKA K, KUMAMOTO T, et al. Emergency versus elective living-donor liver transplantation: a comparison of a single center analysis[J]. Surg Today, 2012, 42(5): 453-459. DOI: 10.1007/s00595-011-0040-5.
    [15] 浦燕萍, 顾燕, 杨富, 等. 肝移植患者术后多重耐药鲍曼不动杆菌感染影响因素[J/CD]. 中华肝脏外科手术学电子杂志, 2016, 5(3): 158-162. DOI: 10.3877/cma.j.issn.2095-3232.2016.03.008.

    PU YP, GU Y, YANG F, et al. Influencing factors of multi-drug resistant acinetobacter baumannii infection in patients after liver transplantation[J/CD]. Chin J Hepatic Surg (Electr Edit), 2016, 5(3): 158-162. DOI: 10.3877/cma.j.issn.2095-3232.2016.03.008.
    [16] JAGARLAMUDI N, WONG F. Acute kidney injury: prediction, prognostication and optimisation for liver transplant[J]. Hepatol Int, 2020, 14(2): 167-179. DOI: 10.1007/s12072-020-10018-0.
    [17] DOUCETTE KE, AL-SAIF M, KNETEMAN N, et al. Donor-derived bacteremia in liver transplant recipients despite antibiotic prophylaxis[J]. Am J Transplant, 2013, 13(4): 1080-1083. DOI: 10.1111/ajt.12133.
    [18] 姚运海, 甘建和, 赵卫峰. 4种评分系统对肝硬化合并感染患者预后的评估价值[J]. 临床肝胆病杂志, 2019, 35(1): 87-91. DOI: 10.3969/j.issn.1001-5256.2019.01.016.

    YAO YH, GAN JH, ZHAO WF. Value of four scoring systems in evaluating the prognosis of cirrhotic patients with infection[J]. J Clin Hepatol, 2019, 35(1): 87-91. DOI: 10.3969/j.issn.1001-5256.2019.01.016.
    [19] 陆晔峰, 夏强, 邱必军, 等. 儿童肝移植术后长期生存的相关问题分析[J]. 临床肝胆病杂志, 2019, 35(11): 2396-2401. DOI: 10.3969/j.issn.1001-5256.2019.11.004.

    LU YF, XIA Q, QIU BJ, et al. An analysis of related issues in long-term survival in children after liver transplantation[J]. J Clin Hepatol, 2019, 35(11): 2396-2401. DOI: 10.3969/j.issn.1001-5256.2019.11.004.
    [20] FREIRE MP, OSHIRO IC, PIERROTTI LC, et al. Carbapenem-resistant enterobacteriaceae acquired before liver transplantation: impact on recipient outcomes[J]. Transplantation, 2017, 101(4): 811-820. DOI: 10.1097/TP.0000000000001620.
    [21] CINAR G, KALKAN İA, AZAP A, et al. Carbapenemase-producing bacterial infections in patients with liver transplant[J]. Transplant Proc, 2019, 51(7): 2461-2465. DOI: 10.1016/j.transproceed.2019.02.050.
    [22] FURUICHI M, FUKUDA A, SAKAMOTO S, et al. Characteristics and risk factors of late-onset bloodstream infection beyond 6 months after liver transplantation in children[J]. Pediatr Infect Dis J, 2018, 37(3): 263-268. DOI: 10.1097/INF.0000000000001754.
    [23] SHI SH, KONG HS, JIA CK, et al. Risk factors for pneumonia caused by multidrug-resistant Gram-negative bacilli among liver recipients[J]. Clin Transplant, 2010, 24(6): 758-765. DOI: 10.1111/j.1399-0012.2009.01184.x.
    [24] JUNG JY, PARK MS, KIM SE, et al. Risk factors for multi-drug resistant acinetobacter baumannii bacteremia in patients with colonization in the intensive care unit[J]. BMC Infect Dis, 2010, 10: 228. DOI: 10.1186/1471-2334-10-228.
    [25] KIM YJ, KIM SI, LEE YD, et al. Carbapenem-resistant acinetobacter baumannii bacteremia in liver transplant recipients[J]. Transplant Proc, 2018, 50(4): 1132-1135. DOI: 10.1016/j.transproceed.2018.01.043.
    [26] AVKAN-OGUZ V, OZKARDESLER S, UNEK T, et al. Risk factors for early bacterial infections in liver transplantation[J]. Transplant Proc, 2013, 45(3): 993-997. DOI: 10.1016/j.transproceed.2013.02.067.
    [27] NATORI Y, KASSAR R, IABONI A, et al. Surgical site infections after liver transplantation: prospective surveillance and evaluation of 250 transplant recipients in Canada[J]. Infect Control Hosp Epidemiol, 2017, 38(9): 1084-1090. DOI: 10.1017/ice.2017.131.
    [28] VIEHMAN JA, CLANCY CJ, CLARKE L, et al. Surgical site infections after liver transplantation: emergence of multidrug-resistant bacteria and implications for prophylaxis and treatment strategies[J]. Transplantation, 2016, 100(10): 2107-2114. DOI: 10.1097/TP.0000000000001356.
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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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