肝移植术后多重耐药菌感染特点及危险因素分析

Clinical features 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及相关危险因素,以指导临床识别高危患者,减少多重耐药菌感染的发生。方法收集南京医科大学第一附属医院2019年2月至2020年9月接受肝移植手术的187例患者临床资料,其中男性150例,女性37例,年龄(50.6±9.6)岁。采集多重耐药菌感染相关数据,并通过单因素分析和多因素logistic回归分析确定独立危险因素。结果187例肝移植患者中发生多重耐药菌感染39例,其中9例死亡与其直接相关。肺部感染最多见,占82.1%(32/39);多重耐药鲍曼不动杆菌和耐碳青霉烯类肠杆菌科细菌是最常见菌株,分别占46.8%(36/77)和41.7%(32/77);术后呼吸机使用时间≥48h(OR=3.430,95%CI:1.124~10.467,P=0.030)、重症监护室(ICU)住院时间≥7 d(OR=9.013,95%CI:3.054~26.594,P<0.001)是发生多重耐药菌感染的独立危险因素。结论肝移植患者术后早期拔除气管插管、尽量缩短ICU留置时间对于降低肝移植术后多重耐药菌感染风险非常重要。

Objective To investigate the clinical features and related risk factors of multi-drug resistant organism(MDRO)infection after liver transplantation,so as to guide clinical identification of high-risk patients and reduce the occurrence of MDRO infection.Methods Of 187 patients undergoing liver transplantation in the First Affiliated Hospital of Nanjing Medical University from February 2019 to September 2020 were enrolled,including 150 males and 37 females,aged(50.6±9.6)years.Data related to MDRO infection were collected,and independent risk factors were identified using univariate analysis and multiple logistic regression analysis.Results Among the 187 patients,MDRO infection occurred in 39,and 9 patient deaths were directly related to MDRO infection.Lung is the most common infection site,accounting for 82.1%(32/39)of MDRO infection.The most common pathogenic bacteria were Acinetobacter baumannii and Carbapenem-resistant enterobacteriaceae,accounting for 46.8%(36/77)and 41.7%(32/77)of MDRO infection,respectively.Multiple logistic regression analysis showed that postoperative mechanical ventilation≥48 h(OR=3.430,95%CI:1.124-10.467,P=0.030),intensive care unit(ICU)stay≥7 d(OR=9.013,95%CI:3.054-26.594,P<0.001)were independent risk factors of postoperative MDRO infection.Conclusions Early removal of endotracheal intubation and discharge from ICU are important to reduce the risk of MDRO infection after liver transplantation.