肝移植后多重耐药菌感染的相关危险因素

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

背景:肝移植后多重耐药菌感染严重影响肝移植后患者的存活率和死亡率,多重耐药菌感染治疗的高失败率也引起了关注。目的:分析肝移植后多重耐药菌感染的危险因素。方法:采用队列研究对114例肝移植患者的临床资料进行收集和分析,多重耐药菌感染组共28例;非多重耐药菌感染组共86例。统计多重耐药菌感染率,进行单因素分析及多元Logistic回归分析确定独立危险因素。结果与结论:(1)肝移植后多重耐药菌的感染率为24.6%;(2)多元Logistic回归分析结果显示,4个因素是影响肝移植后多重耐药菌感染的独立危险因素:凝血酶原时间延长(OR:3.102,95%CI0.066-9.024,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);(3)结果显示,凝血酶原时间延长、ICU留置时间≥10 d、气管插管时间≥72 h和胸腔穿刺会增加肝移植后患者发生多重耐药菌感染的风险。

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.