肝移植术后感染病原菌及危险因素

Pathogens isolated from liver transplantation patients with postoperative infection and risk factors

目的探讨肝移植术后感染的危险因素及病原学特征。方法回顾性调查2017年1月-2023年12月于山东第一医科大学第一附属医院行成人肝移植术患者300例的基本信息和临床资料,采用单因素和多因素Logistic回归分析术后感染的危险因素,分析感染病原学分布特点。结果300例行肝移植的患者术后感染42例,感染率为14.00%;多因素Logistic回归分析结果显示,术前有糖尿病,术前使用抗菌药物,术中冷缺血时间偏长,术后发生急性排斥反应是肝移植患者术后感染的独立危险因素(P<0.05);感染部位以下呼吸道、腹盆腔内组织及上呼吸道为主;感染病原菌以鲍氏不动杆菌、屎肠球菌、铜绿假单胞菌和金黄色葡萄球菌为主。结论术前有糖尿病,术前使用抗菌药物,术中冷缺血时间偏长,术后出现急性排斥反应是肝移植患者术后医院感染的高危因素,应针对以上因素采取相应的预防措施。

OBJECTIVE To explore the risk factors and etiological characteristics of postoperative infection in the liver transplantation patients.METHODS A total of 300 patients who underwent liver transplantation in the First Hospital Affiliated to Shandong First Medical University from Jan 2017 to Dec 2023 were enrolled in the study,and the baseline data and clinical data of the subjects were retrospectively investigated.Univariate analysis and multivariate logistic regression analysis were performed for the risk factors for the postoperative infection,and the etiological characteristics of the infection were observed.RESULTS Among the 300 patients who underwent the liver transplantation,42 had postoperative infection,with the incidence of infection 14.00%.The result of multivariate logistic regression analysis showed that preoperative diabetes mellitus,intraoperative use of antibiotics,excessive time of intraoperative cold ischemia and postoperative acute rejection were the independent risk factors for the postoperative infection in the liver transplantation patients(P<0.05).The patients with lower respiratory tract infection,abdominal pelvic tissue infection and upper respiratory tract infection were dominant among the patients with postoperative infection.Acinetobacter baumannii,Enterococcus faecium,Pseudomonas aeruginosa and Staphylococcus aureus were the predominant species of pathogens causing the infection.CONCLUSION The preoperative diabetes mellitus,preoperative use of antibiotics,excessive time of intraoperative cold ischemia and postoperative acute rejection are the high risk factors for the postoperative nosocomial infection in the liver transplantation patients.It is necessary to take targeted prevention measures according to the above factors.