Risk factors for multi-drug resistant organisms infection after liver transplantation

doi:10.3969/j.issn.2095-4344.0572

Abstract

Abstract:

BACKGROUND: Multi-drug resistant organisms (MDRO) infection after liver transplantation seriously affects the survival and mortality of patients after liver transplantation. High failure in MDRO infection treatment catches much attention.
OBJECTIVE: To analyze the risk factors for MDRO infection after liver transplantation.
METHODS: A prospective cohort study was used to collect and analyze the clinical data of 114 patients after liver transplantation. There were 28 cases of MDRO infection, and 86 cases of non-MDRO infection. The MDRO infection rate was calculated. Univariate analysis and multivariate logistic regression analysis were used to screen independent risk factors.
RESULTS AND CONCLUSION: The MDRO infection rate after liver transplantation was 24.6%. Multivariate logistic regression analysis results showed the following four factors: prolonged prothrombin time (OR: 3.102, 95% CI (0.066-9.024), P=0.038), ICU retention time ≥ 10 days (OR: 3.745, 95%CI (1.313-10.687), P=0.014), tracheal intubation time ≥ 72 hours (OR: 8.972, 95%CI (1.983-40.582), P=0.004), thoracentesis (OR: 3.564, 95%CI (1.223-10.387), P=0.020). These results imply that prolonged prothrombin time, ICU indwelling time ≥ 10 days, tracheal intubation time ≥ 72 hours and thoracentesis can increase the risk of MDRO infection in patients after liver transplantation.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Key words: Liver Transplantation, Bacteria, Infection, Prothrombin Time, Risk Factors, Tissue Engineering

CLC Number:

R446

Liu Mengyuan1, Fang Fang2. Risk factors for multi-drug resistant organisms infection after liver transplantation[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(7): 1109-1114.

Figures/Tables 1

2.1 参与者数量分析共收集第一人民医院及仁济医院符合纳入标准的肝移植患者128例，排除术后24 h内死亡的患者3例，转院及研究期间失访的患者5例，病历资料不完整的患者6例，得到可供分析的患者共114例(第一人民医院54例，仁济医院60例)。 2.2 两组患者一般资料共收集第一人民医院及仁济医院符合纳入标准、可供分析的肝移植患者114例，平均年龄(51.88±10.16)岁。多重耐药菌感染组共28例，其中男19例，女9例，原发病为肝细胞癌8例，乙肝肝硬化10例，胆汁性肝硬化2例，酒精性肝硬化2例，其他6例；非多重耐药菌感染组共86例，其中男63例，女23例，原发病为肝细胞癌31例，乙肝肝硬化34例，胆汁性肝硬化6例，酒精性肝硬化4例，其他11例。肝移植术后多重耐药菌感染组的死亡率(5例，17.9%)明显高于非感染组(6例，7.0%)。见表1。 2.3 肝移植后多重耐药菌的感染率及菌株分布情况根据院内多重耐药菌感染的诊断标准，两肝移植中心共28例患者发生多重耐药菌感染，肝移植后患者多重耐药菌感染率为24.6%。在两肝移植中心总患者中，多重耐药革兰阴性菌感染20例(71.4%)，其中第一人民医院多重耐药革兰阴性菌感染14例(77.8%)，仁济医院多重耐药革兰阴性菌感染6例(60.0%)，均以多重耐药鲍曼不动杆菌最常见。多重耐药革兰阳性菌感染8例(28.6%)。其中第一人民医院多重耐药革兰阳性菌感染4例(22.2%)，在仁济医院10例患者中，多重耐药革兰阳性菌感染4例(40.0%)，均以金黄色葡萄球菌最常见。在两肝移植中心总患者中，肺部感染占57.0%。其次是血流感染占25.0%。其中第一人民医院多重耐药菌感染患者中最常见的感染部位是肺部12例(66.7%)，其次是血流感染(11.1%)；在仁济医院最常见的血流感染(50.0%)，其次是肺部感染(40%)。 2.4 肝移植后多重耐药菌感染危险因素的单因素分析首先对数据进行正态性检验，结果显示年龄、体质量指数、血清白蛋白水平及手术时间4个变量基本符合正态分布 (P > 0.05)外，其余各变量均不符合正态分布(P < 0.05)。统计分析结果发现12个因素是肝移植术后发生多重耐药菌感染的潜在危险因素，包括失血量≥3 L、红细胞输入量> 8 U、术中尿量≥1 L、留置ICU时间≥10 d、机械通气时间>24 h、留置气管插管时间≥72 h、留置导尿管时间≥ 5 d、留置胃管时间≥4 d、恢复饮食、再次手术、胸腔穿刺和腹腔内出血。而年龄、性别、腹水、上消化道出血、糖尿病、高血压、血清肌酐、血胆红素、胆道并发症及留置深静脉导管时间≥14 d等差异无显著性意义(P > 0.1)。具体见表1。 2.5 肝移植后多重耐药菌感染多元Logistic回归分析将以上单因素分析中P < 0.1的变量(凝血酶原时间延长、失血量≥3 L、红细胞输入量>8 U、术中尿量≥1 L、留置ICU时间≥10 d、机械通气时间>24 h、留置气管插管时间≥ 72 h、留置导尿管时间≥5 d、留置胃管时间≥4 d、恢复饮食、再次手术、胸腔穿刺和腹腔内出血)纳入非条件Logistic回归中进行分析。结果显示，以下4个因素：凝血酶原时间延长(OR：3.102，95%CI 0.066-9.024，P=0.038)、ICU留置时间≥10 d(OR：3.745，95%CI 1.313-10.687，P=0.014)、气管插管时间≥72 h(OR：8.972，95%CI 1.983-40.582，P=0.004)、胸腔穿刺(OR：3.564，95%CI 1.223-10.387，P=0.020)是影响肝移植后多重耐药菌感染的独立危险因素。具体见表2。"

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