Clinical analysis of early <i>Klebsiella pneumoniae</i> infection after liver transplantation

Zheng Kezhong; Chen Song; He Zhixiang; Wang Guobin; Zhao Hongchuan; Geng Xiaoping; Huang Fan

doi:10.3969/j.issn.1674-7445.2024053

Article Contents

Article Navigation > ORGAN TRANSPLANTATION > 2024 >

Zheng Kezhong, Chen Song, He Zhixiang, et al. Clinical analysis of early Klebsiella pneumoniae infection after liver transplantation[J]. ORGAN TRANSPLANTATION. doi: 10.3969/j.issn.1674-7445.2024053

Citation:

Zheng Kezhong, Chen Song, He Zhixiang, et al. Clinical analysis of early Klebsiella pneumoniae infection after liver transplantation[J]. ORGAN TRANSPLANTATION. doi: 10.3969/j.issn.1674-7445.2024053

Zheng Kezhong, Chen Song, He Zhixiang, et al. Clinical analysis of early Klebsiella pneumoniae infection after liver transplantation[J]. ORGAN TRANSPLANTATION. doi: 10.3969/j.issn.1674-7445.2024053

Citation:

Zheng Kezhong, Chen Song, He Zhixiang, et al. Clinical analysis of early Klebsiella pneumoniae infection after liver transplantation[J]. ORGAN TRANSPLANTATION. doi: 10.3969/j.issn.1674-7445.2024053

PDF( 1198 KB)

Clinical analysis of early Klebsiella pneumoniae infection after liver transplantation

doi: 10.3969/j.issn.1674-7445.2024053

Department of Liver Transplantation, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China

More Information

Corresponding author: Huang Fan, Email: huang_f@vip.126.com
Received Date: 2024-04-18
Available Online: 2024-07-08

Abstract

Abstract

To identify early Klebsiella pneumoniae (KP) infection after liver transplantation and its impact on prognosis. Methods Clinical data of 171 liver transplant recipients were retrospectively analyzed, and they were divided into the non-infection (n=52) and infection groups (n=119) according to the bacterial culture results at postoperative 2 weeks. In the infection group, KP was not detected in 86 cases (non-KP infection group), and KP was cultured in 33 cases (KP infection group). Preoperative, intraoperative and postoperative data were statistically compared between the non-infection and infection groups, and between the non-KP infection and KP infection groups. The risk factors of early KP infection after liver transplantation and the influencing factors of long-term survival of the recipients were analyzed. Results Compared with the non-infection group, model for end-stage liver disease (MELD) score and total bilirubin level were higher, the operation time was longer, the length of postoperative intensive care unit (ICU) stay and the length of hospital stay were longer, the amount of intraoperative red blood cell transfusion was higher, the hospitalization expense was higher, the incidence of severe complications was higher, white blood cell count, absolute neutrophil cell count and neutrophil-to-lymphocyte ratio at postoperative 14 and 30 d were higher, absolute lymphocyte count at postoperative 14 d was lower and hemoglobin level at postoperative 30 d was lower in the infection group. The differences were statistically significant (all P<0.05). Compared with the non-KP infection group, MELD score, total bilirubin level and aspartate aminotransferase (AST) level were higher, the operation time and the length of postoperative ICU stay were longer, the hospitalization expense was higher, the 90-d fatality was higher, the albumin level at postoperative 14 d was lower, and total bilirubin level at postoperative 30 d was higher in the KP infection group. The differences were statistically significant (all P<0.05). Among 33 recipients with KP infection, 16 cases were resistant to carbapenem antibiotics, and 7 of them died within postoperative 90 d. Seventeen cases were intermediate or sensitive to carbapenem antibiotics, and 4 of them died within postoperative 90 d. Preoperative MELD score ≥17 and operation time＞415 min were the independent risk factors for KP infection after liver transplantation (both P<0.05). The length of postoperative ICU stay ≥44 h and KP infection were the independent risk factors for long-term prognosis of liver transplantation (both P<0.05). Conclusions KP infection is an independent risk factor for death after liver transplantation. High preoperative MELD score and long operation time are the independent risk factors for early KP infection after liver transplantation.
- Liver transplantation,
- Infection,
- Klebsiella pneumoniae,
- Carbapenemase,
- Gram negative bacteria,
- End-stage liver disease model,
- Aalanine aminotransferase,
- Aspartate aminotransferase,
- Prognosis

FullText(HTML)

References(38)

References

[1]	MOULOUDI E, MASSA E, PAPADOPOULOS S, et al. Bloodstream infections caused by carbapenemase-producing Klebsiella pneumoniae among intensive care unit patients after orthotopic liver transplantation: risk factors for infection and impact of resistance on outcomes[J]. Transplant Proc, 2014, 46(9): 3216-3218. DOI: 10.1016/j.transproceed.2014.09.159.
[2]	TEZCAN H, ALTUNSOY A, TURAN GÖKÇE D, et al. Multidrug-resistant infections after liver transplantation, etiology and risk factors: a single-center experience[J]. Exp Clin Transplant, 2023, 21(12): 952-960. DOI: 10.6002/ect.2023.0081.
[3]	CHEN IC, DUNGCA LBP, LIN CC, et al. Epidemiology and risk factors of early bacterial infections after pediatric living donor liver transplantation[J]. Transplant Proc, 2024, 56(3): 625-633. DOI: 10.1016/j.transproceed.2024.02.014.
[4]	张文, 朱传龙. 肝移植后免疫抑制状态下继发感染对策及展望[J]. 医学研究生学报, 2022, 35(7): 673-679. DOI: 10.16571/j.cnki.1008-8199.2022.07.001. ZHANG W, ZHU CL. Conntermeasure and prospect of secondary infection under immunosuppression after liver transplantation[J]. J Med Postgrad, 2022, 35(7): 673-679. DOI: 10.16571/j.cnki.1008-8199.2022.07.001.
[5]	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.
[6]	王文静, 张靖垚, 张晓刚, 等. 肝衰竭患者肝移植后细菌感染特征及危险因素分析[J]. 中华消化外科杂志, 2023, 22(11): 1343-1350. DOI: 10.3760/cma.j.cn115610-20230913-00093. WANG WJ, ZHANG JY, ZHANG XG, et al. Analysis of characteristics and risk factors of bacterial infection in patients undergoing liver transplantation for liver failure[J]. Chin J Dig Surg, 2023, 22(11): 1343-1350. DOI: 10.3760/cma.j.cn115610-20230913-00093.
[7]	LIU N, YANG G, DANG Y, et al. Epidemic, risk factors of carbapenem-resistant Klebsiella pneumoniae infection and its effect on the early prognosis of liver transplantation[J]. Front Cell Infect Microbiol, 2022, 12: 976408. DOI: 10.3389/fcimb.2022.976408.
[8]	刘淼, 王策, 穆红. 儿童肝移植患者术后感染病原菌的分布以及耐药情况[J]. 实用医学杂志, 2022, 38(22): 2861-2867. DOI: 10.3969/j.issn.1006-5725.2022.22.018. LIU M, WANG C, MU H. Pathogenic bacteria distribution and drug resistance analysis after liver transplantation in children[J]. J Pract Med, 2022, 38(22): 2861-2867. DOI: 10.3969/j.issn.1006-5725.2022.22.018.
[9]	范铁艳, 李君, 陈虹. 肝移植术后肺炎克雷伯杆菌感染[J/OL]. 实用器官移植电子杂志, 2023, 11(1): 65-68. DOI: 10.3969/j.issn.2095-5332.2023.01.016. FAN T Y, LI J, CHEN H. Klebsiella pneumoniae infection after liver transplantation[J/OL]. Pract J Organ Transplant (Electr Vers), 2023, 11(1): 65-68. DOI: 10.3969/j.issn.2095-5332.2023.01.016.
[10]	GUO L, PENG P, PENG WT, et al. Klebsiella pneumoniae infections after liver transplantation: Drug resistance and distribution of pathogens, risk factors, and influence on outcomes[J]. World J Hepatol, 2024, 16(4): 612-624. DOI: 10.4254/wjh.v16.i4.612.
[11]	JEROME E, CAVAZZA A, MENON K, et al. Systematic review and meta-analysis of the diagnostic accuracy of procalcitonin for post-operative sepsis/infection in liver transplantation[J]. Transpl Immunol, 2022, 74: 101675. DOI: 10.1016/j.trim.2022.101675.
[12]	TU ZH, JIN PB, CHEN DY, et al. Infection evaluation in the early period after liver transplantation: a single-center exploration[J]. Transpl Infect Dis, 2023, 25(2): e14002. DOI: 10.1111/tid.14002.
[13]	OH SH, JEONG IS, KIM DY, et al. Recent improvement in survival outcomes and reappraisal of prognostic factors in pediatric living donor liver transplantation[J]. Liver Transpl, 2022, 28(6): 1011-1023. DOI: 10.1002/lt.26308.
[14]	GUO W, SHENG J, GU Y, et al. Analysis and forecast for multidrug-resistant Acinetobacter baumannii Infections among liver transplant recipients[J]. Transplant Proc, 2014, 46(5): 1448-1452. DOI: 10.1016/j.transproceed.2014.02.027.
[15]	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.
[16]	吴小霞, 吴灵俐, 舒琳, 等. 肝移植术后革兰氏阳性球菌的感染特点及防治效果[J]. 中南大学学报(医学版), 2023, 48(5): 707-715. DOI: 10.11817/j.issn.1672-7347.2023.220631. WU XX, WU LL, SHU L, et al. Characteristics of Gram-positive cocci infection and the therapeutic effect after liver transplantation[J]. J Cent South Univ Med Sci, 2023, 48(5): 707-715. DOI: 10.11817/j.issn.1672-7347.2023.220631.
[17]	FRICKER ZP, MUKTHINUTHALAPATI VVPK, AKINYEYE S, et al. MELD-Na is more strongly associated with risk of infection and outcomes than other characteristics of patients with cirrhosis[J]. Dig Dis Sci, 2021, 66(1): 247-256. DOI: 10.1007/s10620-020-06164-y.
[18]	HUNG HC, LEE JC, WANG YC, et al. Living-donor liver transplantation for hepatocellular carcinoma: impact of the MELD score and predictive value of NLR on survival[J]. Curr Oncol, 2022, 29(6): 3881-3893. DOI: 10.3390/curroncol29060310.
[19]	宓宏潮, 房炯泽, 吴胜东, 等. 肝移植术后早期感染危险因素分析及预测[J/OL]. 中华移植杂志(电子版), 2022, 16(4): 216-223. DOI: 10.3877/cma.j.issn.1674-3903.2022.04.004. MI HC, FANG JZ, WU SD, et al. Risk factors analysis and predicition on early infection after liver transplantation[J]. Chin J Transplant (Electr Edit), 2022, 16(4): 216-223. DOI: 10.3877/cma.j.issn.1674-3903.2022.04.004.
[20]	HORVATH KA, ACKER MA, CHANG H, et al. Blood transfusion and infection after cardiac surgery[J]. Ann Thorac Surg, 2013, 95(6): 2194-2201. DOI: 10.1016/j.athoracsur.2012.11.078.
[21]	HAWKINS RB, RAYMOND SL, STORTZ JA, et al. Chronic critical illness and the persistent inflammation, immunosuppression, and catabolism syndrome[J]. Front Immunol, 2018, 9: 1511. DOI: 10.3389/fimmu.2018.01511.
[22]	JIANG Y, JIANG FQ, KONG F, et al. Inflammatory anemia-associated parameters are related to 28-day mortality in patients with sepsis admitted to the ICU: a preliminary observational study[J]. Ann Intensive Care, 2019, 9(1): 67. DOI: 10.1186/s13613-019-0542-7.
[23]	韩铎, 何宏, 王宏伟, 等. 肝移植术后感染病原菌分布及耐药性分析[J]. 临床肝胆病杂志, 2023, 39(6): 1366-1373. DOI: 10.3969/j.issn.1001-5256.2023.06.017. HAN D, HE H, WANG HW, et al. Distribution and drug resistance of pathogenic bacteria for infection after liver transplantation[J]. J Clin Hepatol, 2023, 39(6): 1366-1373. DOI: 10.3969/j.issn.1001-5256.2023.06.017.
[24]	CHEN F, ZHONG H, YANG T, et al. Ceftazidime-avibactam as salvage treatment for infections due to carbapenem-resistant Klebsiella pneumoniae in liver transplantation recipients[J]. Infect Drug Resist, 2021, 14: 5603-5612. DOI: 10.2147/IDR.S342163.
[25]	李斯婕, 覃金爱, 杨志勇. 100例肝移植术患儿术后早期感染的病原菌分布及耐药情况[J]. 山东医药, 2022, 62(14): 78-82. DOI: 10.3969/j.issn.1002-266X.2022.14.019. LI SJ, QIN JA, YANG ZY. Distribution and drug resistance of pathogens causing early postoperative infection in 100 children after liver transplantation[J]. Shandong Med J, 2022, 62(14): 78-82. DOI: 10.3969/j.issn.1002-266X.2022.14.019.
[26]	LIU N, YANG G, DANG Y, et al. Epidemic, risk factors of carbapenem-resistant Klebsiella pneumoniae infection and its effect on the early prognosis of liver transplantation[J]. Front Cell Infect Microbiol, 2022, 12: 976408. DOI: 10.3389/fcimb.2022.976408.
[27]	VARGHESE J, JAYANTHI V, RELA M. Mortality associated with carbapenem-resistant Klebsiella pneumoniae infections in liver transplant recipients[J]. Liver Transpl, 2012, 18(9): 1124-1125. DOI: 10.1002/lt.23464.
[28]	MAZZA E, PROSPERI M, PANZERI MF, et al. Carbapenem-resistant klebsiella pneumoniae infections early after liver transplantation: a single-center experience[J]. Transplant Proc, 2017, 49(4): 677-681. DOI: 10.1016/j.transproceed.2017.02.028.
[29]	潘志豪, 刘志武, 郝裕霞, 等. 终末期肝疾病模型评分对肝移植患者预后影响及氧供在其中的作用[J]. 山西医药杂志, 2023, 52(19): 1460-1464. DOI: 10.3969/j.issn.0253-9926.2023.19.004. PAN ZH, LIU ZW, HAO YX, et al. Effects of MELD on prognosis in patients undergoing liver transplantation and the role of intraoperative oxygen delivery[J]. Shanxi Med J, 2023, 52(19): 1460-1464. DOI: 10.3969/j.issn.0253-9926.2023.19.004.
[30]	WOZNIAK JE, BAND VI, CONLEY AB, et al. A nationwide screen of carbapenem-resistant Klebsiella pneumoniae reveals an isolate with enhanced virulence and clinically undetected colistin heteroresistance[J]. Antimicrob Agents Chemother, 2019, 63(5): e00107-e00119. DOI: 10.1128/AAC.00107-19.
[31]	DONG N, LIN D, ZHANG R, et al. Carriage of blaKPC-2 by a virulence plasmid in hypervirulent Klebsiella pneumoniae[J]. J Antimicrob Chemother, 2018, 73(12): 3317-3321. DOI: 10.1093/jac/dky358.
[32]	YANG X, SUN Q, LI J, et al. Molecular epidemiology of carbapenem-resistant hypervirulent Klebsiella pneumoniae in China[J]. Emerg Microbes Infect, 2022, 11(1): 841-849. DOI: 10.1080/22221751.2022.2049458.
[33]	DING L, SHEN S, CHEN J, et al. Klebsiella pneumoniae carbapenemase variants: the new threat to global public health[J]. Clin Microbiol Rev, 2023, 36(4): e0000823. DOI: 10.1128/cmr.00008-23.
[34]	DI PILATO V, POLLINI S, MIRIAGOU V, et al. Carbapenem-resistant Klebsiella pneumoniae: the role of plasmids in emergence, dissemination, and evolution of a major clinical challenge[J]. Expert Rev Anti Infect Ther, 2024, 22(1/2/3): 25-43. DOI: 10.1080/14787210.2024.2305854.
[35]	莫银竹, 宋沧桑, 李志伟, 等. 耐碳青霉烯肺炎克雷伯菌耐药机制及治疗策略的研究进展[J]. 中国药物评价, 2023, 40(3): 217-223. DOI: 10.3969/j.issn.2095-3593.2023. 03.005. MO YZ, SONG CS, LI ZW, et al. Research progress on drug resistance mechanism and treatment strategies of carbapenem-resistant Klebsiella pneumoniae[J]. Chin J Drug Eval, 2023, 40(3): 217-223. DOI: 10.3969/j.issn.2095-3593.2023.03.005.
[36]	KARAMPATAKIS T, TSERGOULI K, BEHZADI P. Carbapenem-resistant Klebsiella pneumoniae: virulence factors, molecular epidemiology and latest updates in treatment options[J]. Antibiotics, 2023, 12(2): 234. DOI: 10.3390/antibiotics12020234.
[37]	中华医学会器官移植学分会. 器官移植术后耐药菌感染诊疗技术规范(2019版)[J]. 器官移植, 2019, 10(4): 352-358. DOI: 10.3969/j.issn.1674-7445.2019.04.002. Branch of Organ Transplantation of Chinese Medical Association. Technical specification for diagnosis and treatment of drug-resistant bacterial infection after organ transplantation (2019 edition)[J]. Organ Transplant, 2019, 10(4): 352-358. DOI: 10.3969/j.issn.1674-7445.2019.04.002.
[38]	袁喆, 钱克莉, 王忠杰. 耐碳青霉烯肺炎克雷伯菌耐药机制及治疗策略[J]. 西南医科大学学报, 2024, 47(2): 104-110. DOI: 10.3969/j.issn.2096-3351.2024.02.003. YUAN Z, QIAN KL, WANG ZJ. Drug resistance mechanism and future treatment strategy of carbapenem resistant Klebsiella pneumoniae[J]. J Southwest Med Univ, 2024, 47(2): 104-110. DOI: 10.3969/j.issn.2096-3351.2024.02.003.

Relative Articles

Supplements(0)

Cited By

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Figures(1) / Tables(8)

Get Citation

PDF

XML

Article Metrics

Article views (7) PDF downloads(0)

Clinical analysis of early Klebsiella pneumoniae infection after liver transplantation

doi: 10.3969/j.issn.1674-7445.2024053

Abstract

References

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

Clinical analysis of early Klebsiella pneumoniae infection after liver transplantation

doi: 10.3969/j.issn.1674-7445.2024053

Abstract

References

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

Export File

Citation

Format

Content