肝移植术后多重耐药菌感染分布特征及危险因素

Distribution and risk factors of multi-drug resistant bacteria infection after liver transplantation

目的探讨肝移植术后多重耐药菌感染的分布特征和危险因素,为制定更合理的感染控制策略提供依据。方法收集西安交通大学第一附属医院2014年1月至2018年12月接受肝移植手术的患者临床资料,采集多重耐药菌感染相关数据,并通过单因素分析和多元Logistic回归分析确定独立危险因素。结果431例肝移植患者中发生多重耐药菌感染53例,3例死亡与其相关。其中肺部感染最多见,占54.72%;耐碳青霉烯类鲍曼不动杆菌(CR-AB)是最常见菌株,占34.62%。术后ICU留置时间≥7 d(OR 2.303,95%CI 1.123~4.725,P=0.023)、急性肾功能衰竭(OR 4.573,95%CI 1.418~14.749,P=0.011)是发生多重耐药菌感染的独立危险因素(P<0.05)。结论多重耐药菌感染严重威胁肝移植患者的预后,缩短术后ICU留置时间、保护肾功能对于早期预防肝移植术后多重耐药菌感染尤为重要。

Objective To investigate the distribution and risk factors of multiple-drug resistant bacteria(MDRO)infection after liver transplantation,and to provide the basis for making a more reasonable control program.Methods The clinical data of patients who received liver transplantation in the First Affiliated Hospital of Xi’an Jiaotong University from Jan.2014 to Dec.2018 were selected.The infection rate of MDRO was counted,and single factor analysis and multiple Logistic regression analysis were employed to determine the independent risk factors.Results Among the 431 cases of liver transplantation,53 cases had MDRO infection(infection rate 12.29%),and 3 death cases were related to MDRO infection.The pulmonary infection was the most common type,accounting for 54.72%.The most common bacteria were Acinetobacter baumannii,accounting for 34.62%.Multiple Logistic regression analysis showed that ICU retention time≥7 d(OR 2.303,95%CI 1.123~4.725,P=0.023),and acute renal failure(OR 4.573,95%CI 1.418~14.749,P=0.011)were independent risk factors of MDRO infection after liver transplantation.Conclusion MDRO infection is a serious threat to the prognosis of liver transplantation patients.It is very important to shorten ICU retention time and protect renal function for early prevention of MDRO infection after liver transplantation.