86例肝移植术后抗菌素使用的合理性分析

目的 分析肝移植术后细菌性感染的特征、抗菌素使用与细菌性感染之间的关系,评价肝移植术后抗菌素使用的合理性,探讨预防高水平耐药细菌性感染的措施. 方法回顾性分析86例肝移植术后感染的主要病原菌、抗菌素使用量,采用限定日剂量、用药频度、药物利用指数评价抗菌素使用的合理性,运用三维试验检测革兰阴性杆菌产超广谱β-内酰胺酶、AmpC β-内酰胺酶情况.结果 肝移植术后感染主要病原菌为粪肠球菌、阴沟肠杆菌、真菌,大肠杆菌,术前抗菌素使用率为83.7%,以单一抗菌素使用为主,术后抗菌素使用率达100.0%,以二联、三联抗菌素使用为主,抗菌素使用量居前3位为头孢菌素、含酶抑制剂复合抗菌素与青霉素类抗菌素,药物利用指数大于1.1的抗菌素包括氨苄西林、替考拉林,革兰阴性杆菌产超广谱β-内酰胺酶、AmpCβ-内酰胺酶分别为43.3%,31.8%,同时产两种酶的细菌占21.3%. 结论肝移植术后细菌性感染发生率高,抗菌素使用量大,频率高,抗菌素使用基本合理,易发生高耐药性细菌性感染,预防高耐药性细菌性感染十分重要.     

重症监护病房下呼吸道感染常见病原菌的分布与耐药性

目的调查我院重症监护病房(ICU)下呼吸道感染病原菌的分布与耐药情况。方法对本院ICU病房116例下呼吸道感染病人所分离的感染菌株及对抗生素耐药性进行回顾性分析。结果主要菌群有铜绿假单孢菌(25.0%)、肺炎克雷伯菌(18.4%)、鲍曼不动杆菌(14.3%)和大肠埃希菌(9.2%)等。但葡萄球菌、肠球菌等阳性球菌(9.2%)及真菌(13.3%)也有增加趋势。头孢哌酮-舒巴坦和亚胺培南仍保持最高抗菌活性,细菌的耐药率分别为16.9%和24.4%。铜绿假单孢菌,对阿米卡星、头孢哌酮-舒巴坦、亚胺培南的敏感率较高。结论我院ICU病房下呼吸道感染主要病原菌是革兰氏阴性菌,对常用抗菌药物耐药性较高,但革兰氏阳性球菌及真菌所占比例呈增高趋势,加强耐药性监测,合理使用抗生素十分重要。     

肺癌晚期合并肺部感染的临床研究

目的探讨晚期肺癌合并肺部感染的特点和治疗方法。方法分析了110例晚期肺癌合并肺部感染患者的临床资料。结果晚期肺癌合并肺部感染临床比较常见,表现多样性致病菌以革兰氏阴性杆菌和革兰氏阳性球菌,真菌为主,其中革兰氏阴性杆菌阳性率达59.1%（65/110）,本病预后差。结论晚期肺癌合并肺部感染临床表现不典型,病原菌以革兰氏阴性菌最常见,对不同抗生素有一定的耐药性,临床上应根据药敏试验选择抗生素。     

内镜逆行胰胆管造影患者术后胆道感染的病原学分析及治疗

目的探究内镜逆行胰胆管造影(ERCP)术后患者胆道感染的原因及病原种类和耐药性,依据感染原因及病原种类为临床治疗提供相关参考。方法对莱芜市人民医院消化内科2009年3月-2013年3月740例行ERCP手术患者进行临床分析,根据梗阻部位分为:肝门组、肝总管组、胆总管组及胆管未见异常组,比较各组间感染的发生率;通过抽取胆道感染者的血样进行病原菌培养,对病原菌的含量进行分析。结果 740例患者有200例发生感染,总感染率为27.03%,肝门梗阻感染者120例,感染率为81.08%,肝总管组感染48例,感染率为40.00%,胆总管组感染22例,感染率为8.87%,胆管未见异常组感染10例,感染率为4.46%,四组之间相比,差异有统计学意义(P0.05);通过对感染者术后血液或者胆汁培养致病菌得到320株,其中革兰氏阴性占70.00%,革兰氏阳性菌占30.00%,占前三位的菌株分别是:大肠埃希菌、尿肠球菌和粪肠球菌;通过药敏试验可知革兰氏阴性菌对亚胺培南100%敏感,革兰氏阳性菌对万古霉素100%敏感,病原菌对其他抗菌药物均有一定的耐药性。结论 ERCP术后感染和梗阻部位有着显著的相关性,因此要依据梗阻部位做好防止感染发生的准备;通过病原菌的培养和耐药性的检测,从而提高ERCP术后胆道感染控制率,为临床治疗提供参考。     

下呼吸道感染常见病原菌分布及耐药性分析

目的了解下呼吸道感染常见病原菌的分布及耐药性,为临床合理用药提供参考依据。方法收集我院2011年1月至12月下呼吸道感染患者1 123例的痰标本分离的病原菌,进行细菌鉴定和药敏试验。结果共分离出385株病原菌。其中革兰氏阴性杆菌287株,占74.5%;革兰氏阳性球菌83株,占21.6%;真菌15株,占3.9%。革兰氏阴性杆菌中前3位依次为：大肠埃希菌、鲍氏不动杆菌、铜绿假单胞菌。革兰氏阳性球菌中前3位为：金黄色葡萄球菌、溶血性葡萄球菌、表皮葡萄球菌。革兰氏阴性杆菌对抗生素的耐药率高,未发现有耐万古霉素的葡萄球菌。结论革兰氏阴性杆菌是下呼吸道感染的主要致病菌,其药敏结果表明耐药性较高。耐甲氧西林菌株（MRS）出现率高,临床医生需根据药敏结果合理选用抗生素。     

重症医学科老年呼吸机相关性肺炎的病原菌特点及耐药性分析

目的探讨重症医学科老年呼吸机相关性肺炎(VAP)的病原菌特点及耐药性。方法回顾性分析该院2005²013年重症医学科120例老年VAP患者的下呼吸道分泌物病原菌特点,分析各种病原菌对常见抗生素的耐药性。结果 120例VAP患者存活112例,死亡8例,其中有10例有混合感染。共检出病原菌182株,其中革兰阴性杆菌136株(74.73%),主要有铜绿假单胞菌(23.08%)、肺炎克雷伯菌(17.03%)、大肠埃希菌(13.19%)、鲍氏不动杆菌(9.89%)等;革兰阳性菌30株(16.48%),主要有金黄色葡萄球菌、表皮球菌;真菌16株(8.79%),主要为白色念球菌。耐药结果:常见的革兰阴性菌对抗生素耐药性不同,但均对阿米卡星、左氧氟沙星、头孢他啶有一定的敏感性;金黄色葡萄球菌和表皮球菌对庆大霉素、青霉素、环丙沙星、克林霉素均产生明显的耐药性,但对万古霉素、替拉考宁、利奈唑胺高度敏感。结论重症医学科老年VAP患者以革兰阴性菌为主,不同病原菌对抗生素耐药不同,在治疗时要进行细菌培养和药敏试验,明确病原菌类别和耐药性,合理选择抗生素。     

异体输血患者术后感染病原菌和大肠埃希菌感染毒力因子的分布及与耐药性的关系北大核心CSCD

目的探讨异体输血患者术后感染病原菌和大肠埃希菌感染毒力因子分布及与耐药性的交互关系。方法选取本院2017-2020年外科手术患者125例,其中采用回收式自身输血的患者73例(自身输血组),异体输血的患者52例(异体输血组)。对两组患者术后感染病原菌进行鉴定,PCR检测术后大肠埃希菌感染毒力因子,对两组患者病原菌分离株的耐药性进行药敏试验,采用皮尔逊相关性分析异体输血患者术后感染病原菌及大肠埃希菌感染毒力因子与耐药性的交互关系。结果异体输血组52例患者共分离出50株病原菌,其中革兰阳性球菌占34.00%(17/50),革兰阴性杆菌占48.00%(24/50),真菌占18.00%(9/50);自身输血组73例患者共分离出61株病原菌,其中革兰阳性球菌占31.15%(19/61),革兰阴性杆菌占49.18%(30/61),真菌占19.67%(12/61)。两组比较差异有统计学意义(P<0.05)。异体输血组术后各大肠埃希菌感染毒力因子fimH、traT、aerJ、Einv、papGⅢ、pAI、cnf1、fyuA、cnf2、papC、papG、hlyA检出率均高于自身输血组(P<0.05);异体输血组病原菌分离株对氨苄青霉素、氨曲南、氨节西林舒巴坦、头孢唑林头孢他啶、头孢吡肟、左氧氟沙星、呋喃妥因、复方新诺明的耐药率均高于自身输血组(P<0.05);皮尔逊相关性分析结果显示,术后感染病原菌分布数和大肠埃希菌感染毒力因子分布数均与耐药性有相关性(r=0.336,0.427,均P<0.05)。结论异体输血组术后大肠埃希菌感染产生的毒力因子多于自身输血组,异体输血组病原菌分离株对大多数抗菌药物的耐药率高于自身输血组,术后感染病原菌分布数和大肠埃希菌感染毒力因子分布数均与耐药性有交互关系。     

住院患儿细菌性腹泻的病原菌分布与耐药性情况观察

目的研究本院住院患儿细菌性腹泻的病原菌分布与耐药性,对患儿细菌性腹泻临床治疗的经验性抗菌药物方案选择进行指导.方法选取2012-05/2017-10期间我院收治的细菌性腹泻患儿1107例进行回顾性分析,根据所有患儿的临床资料(包括病案、实验室检查结果、粪便病原学检查结果和药敏实验结果),统计1107例细菌性腹泻患儿的粪便病原菌分布和构成、临床症状、主要病原菌的耐药性及患儿治疗后的效果和预后.结果在1107例细菌性腹泻患儿的粪便中共分离鉴定得到病原菌206株,其中革兰氏阳性菌(如金黄色葡萄球菌)39例,革兰氏阴性菌(如志贺菌属、致病性大肠埃希菌属、沙门氏菌属)167例.患儿粪便中病原菌的检出率以1岁的婴幼儿最高,检出率随年龄的增加而减少.而且全年均有病原菌检出,尤其是夏季的病原菌检出率最高.而且致病性大肠埃希菌与金黄色葡萄球菌导致的发热、腹痛、排便次数、里急后重及脱水等细菌性腹泻临床症状发生率具有统计学差异(P0.05).主要的革兰氏阳性菌对抗菌药物莫西沙星、万古霉素、利奈唑胺的耐药率小于30%,主要的革兰氏阴性菌对头孢类抗菌药头孢他啶、复方新诺明、美罗培南和亚胺培南的耐药率小于30%.1107例细菌性腹泻患儿通过经验性抗菌药物和选择敏感抗菌药物进行治疗后,1 wk后的治愈率达96.48%(1068/1107).结论儿童细菌性腹泻的病原菌分布情况复杂,临床医生需参考患儿的病原菌组成和分布情况以及药敏检测结果选择患儿耐药率小于30%的抗菌药物对细菌性腹泻进行治疗.     

124株肠球菌的分离率及耐药性分析

肠球菌为条件致病菌，是引起医院感染的重要病原菌之一。近年来，与肠球菌有关的感染发生率和病死率明显升高，医院感染中〉10％由肠球菌所致，其中最常见的为尿路感染，其次为腹部和盆腔等部位的创伤和外科术后感染。由于肠球菌的耐药机制较为复杂，它对常用的抗生素有天然耐药性、获得性耐药的特点，限制了治疗药物的应用，对肠球菌耐药性的分析可为临床治疗提供信息和依据。为此，笔者2006年1月-2007年1月对我院临床分离的肠球菌进行了药敏试验，分析其耐药性的特点，并对临床用药进行探讨。结果报告如下。     

细菌性肠炎病患儿病原菌分布及药敏结果分析

目的分析住院细菌性肠炎病患儿病原菌分布及药敏结果。方法选取2015年1月至2017年12月安徽省儿童医院收治的198例细菌性肠炎病患儿,对其病原菌进行分离鉴定及药物敏感试验分析。结果 198例患儿共分离鉴定出228株菌株,其中革兰阳性球菌49株(21. 49%)、革兰阴性杆菌179株(78. 51%);药敏试验结果提示不同病原菌对临床常用抗菌药物的耐药性相差较为明显。根据药敏试验结果选用敏感抗菌药物治疗后革兰阳性球菌感染所致的细菌性肠炎病患儿退热时间(2. 08±0. 22) d、住院时间(4. 35±0. 25) d,与革兰阴性杆菌感染所致的细菌性肠炎病患儿(2. 12±0. 20) d、(4. 41±0. 30) d相比,不同病原菌感染所致细菌性肠炎患儿转归差异无统计学意义(P 0. 05)。结论革兰阴性杆菌为细菌性肠炎病患儿的主要病原菌,对于临床常用抗菌药物存在着不同程度的耐药性,需根据药敏试验结果筛选治疗药物以获取最佳疗效。     

肝移植病人术后早期病原学与感染的临床研究

目的 探讨肝移植术后病人感染的临床特点，以助临床处理。方法 对54例肝移植病人术后针对感染进行各个系统定期检测，观察感染发生时间、部位、病原谱及药物敏感性等指标。结果 54例病人中感染率为51．9％，2例因感染致死。89．3％的感染发生在术后1月内。感染的病原菌依次为肺炎克雷伯菌、铜绿假单胞菌、粪肠球菌、鲍蔓／溶血不动杆菌等。呼吸道感染占92．8％，其中单独呼吸道感染占42．8％，呼吸道合并其他部位感染占50．0％；53．8％的呼吸道感染是多种病原菌混合感染，大多伴有真菌感染，胆道、腹腔等其它部位感染以单一病原菌为主。病原菌中G^ 菌对万古霉素敏感性较高，对头孢类和其它大部分抗生素有较高耐药率；G^-菌对亚胺硫霉素普遍敏感，而对其它抗生素表现出不同程度的耐受。结论 肝移植病人术后感染是影响存活的重要因素，应重视移植术前后对病人的监测和预防性抗生素处理等措施；在处理感染病情时，应综合考虑病原菌谱、药敏结果、多部位复合感染及混合感染等因素。     

原位肝移植术后肺部感染及危险因素分析

目的探讨原位肝移植术后肺部感染的特点及其危险因素，以提高肝移植术后肺部感染的诊治水平。方法对250例原位肝移植术后肺部感染患者的资料进行了回顾性分析，以术前、术中及术后主要的临床表现和实验室指标作为研究对象，分析肺部感染组和对照组间的差别。结果250例原位肝移植患者中，57例术后共发生肺部感染72次，肺部感染率为22．8％（57／250）。最常见为细菌感染，单一细菌感染36例次，两种细菌感染5例次，多种细菌同时感染6例次。其次为真菌感染13例次，占18．1％（13／72），其中7例次合并细菌感染。病毒感染12例次，占16．7％（12／72），均为巨细胞病毒感染，其中3例次合并细菌感染。肺部感染组术后1、2、3年生存率分别为71．9％、61．4%、53．4%，对照组分别为93．1％、75．8％、67．2％（P〈0．05）。Logistic回归分析表明肝移植患者有术前感染、机械通气时间大于12h、手术时间、术中输血总量〉1000 ml、术后再次手术史、术后胸水、重症监护室住院天数这7个因素是术后肺部感染的独立危险因素。结论肺部感染以细菌感染为主，但多种病原菌的混合感染以及多重耐药菌日益增多。在临床工作中应重视对相关危险因素的控制，早期诊断、早期治疗是治疗成功的关键。     

Bacterial infection after liver transplantation

Infectious complications are major causes of morbidity and mortality after liver transplantation, despite recent advances in the transplant field. Bacteria, fungi, viruses and parasites can cause infection before and after transplantation. Among them, bacterial infections are predominant during the first two months post-transplantation and affect patient and graft survival. They might cause surgical site infections, including deep intra-abdominal infections, bacteremia, pneumonia, catheter-related infections and urinary tract infections. The risk factors for bacterial infections differ between the periods after transplant, and between centers. Recently, the emergence of multi-drug resistant bacteria is great concern in liver transplant (LT) patients. The instructive data about effects of infections with extended-spectrum beta lactamase producing bacteria, carbapenem-resistant gram-negative bacteria, and glycopeptide-resistant gram-positive bacteria were reported on a center-by-center basis. To prevent post-transplant bacterial infections, proper strategies need to be established based upon center-specific data and evidence from well-controlled studies. This article reviewed the recent epidemiological data, risk factors for each type of infections and important clinical issues in bacterial infection after LT.     

Multidrug resistant gram-negative bacilli as predominant bacteremic pathogens in liver transplant recipients

Background. Bacteremias, which are often caused by gram‐negative bacteria, are the most frequently occurring infectious complications after liver transplantation (LT). The aim of this study was to investigate bacteremic incidence, pathogenic spectrum, risk factors for bacteremia due to multidrug resistant (MDR) gram‐negative bacilli, and its impact on mortality after LT. Methods. A cohort analysis of prospectively recorded data was done in 475 LT recipients, who were divided into 3 categories: cases with gram‐negative bacteremia, cases with MDR gram‐negative bacteremia, and cases without bacteremia as controls. Results. In 475 LT recipients, there were 152 (32.0%) patients with gram‐negative bacillus bacteremia in the first 6 months after LT. Out of 152 patients, there were 225 bacteremic episodes, which accounted for 69.7% in a total 323 bacteremic episodes. A total of 190 bacteremic episodes were caused by Stenotrophomonas maltophilia, Enterobacteriaceae, Ochrobactrum anthropi, Pseudomonas, and Acinetobacter baumanii, all of which were the most frequent gram‐negative isolates in this study, and MDR bacilli constituted 56.3%. The most frequent source was intravascular catheters. There were 70 patients with MDR gram‐negative bacillus bacteremia. Independent risk factors for bacteremia due to MDR gram‐negative bacillus were as follows: post‐LT abdominal infection (P<0.0001, odds ratio [OR] 0.066, 95% confidence interval [CI] 0.019–0.226), post‐LT reoperative episodes (P<0.0001, OR 10.505, 95% CI 3.055–36.121), or one or more episodes of acute rejection (P=0.042, OR 4.457, 95% CI 0.988–20.103). In the first 6 months after LT, MDR gram‐negative bacillus bacteremia‐related mortality was significantly higher than that due to antibiotic‐susceptible bacillus (38.6% vs. 14.6%, P<0.001). Conclusion. Post‐LT bacteremias caused by MDR gram‐negative bacilli are common, and associated with allograft acute rejection, post‐LT reoperation, and abdominal infection. The increasing isolates of MDR gram‐negative bacilli pose a great challenge for clinical treatment.     

Donor-derived bacterial infections in lung transplant recipients in the era of multidrug resistance

ObjectivesOur aim was to analyze the prevalence of multidrug-resistant bacterial infections in lung transplant donors and to evaluate its influence on donor-derived bacterial infections.MethodsWe conducted a retrospective study of adult patients who underwent lung transplantation (2013–2016) at our hospital. Donor-derived bacterial infection was defined as the isolation of the same bacteria with identical antibiotic susceptibility patterns in the recipient and the perioperative cultures from the donor during the first month posttransplantation. We utilized a preventive antibiotic strategy adapted to the bacteria identified in donor cultures using systemic and nebulized antibiotics.Results252 lung transplant recipients and 243 donors were included. In 138/243 (56.8%) donors, one bacterial species was isolated from at least one sample; graft colonization (118/243; 48.6%), blood cultures (5/243; 2.1%) and the contamination of preservation fluids (56/243; 23%). Multidrug-resistant bacteria were isolated from 12/243 (4.9%) donors; four Enterobacterales, four Stenotrophomonas maltophilia, three Pseudomonas aeruginosa and one methicillin-resistant Staphylococcus aureus. There was no transmission of these multidrug-resistant bacteria. Donor-derived infections, primarily tracheobronchitis due to non-MDR bacteria, were diagnosed in 7/253 (2.9%) recipients, with good clinical outcomes.ConclusionsThe lungs of donors colonized with multidrug-resistant bacteria may be safely used when recipients receive prompt tailored antibiotic treatment.     

社区及医院感染中常见细菌的耐药性分析

目的探讨社区和医院感染中细菌耐药谱的特点。方法药敏试验用KirbyBauer法,根据2003年美国临床实验室标准化委员会(NCCLS)标准判定结果,应用WHONET-5软件对临床分离细菌的药敏结果进行数据分析。结果医院感染480株,常见细菌依次为:铜绿假单胞菌(19.37%),肺炎克雷伯菌(15.83%),大肠埃希菌(11.87%)。社区感染726株,常见细菌为:金黄色葡萄球菌(14.05%),大肠埃希菌(12.67%),凝固酶阴性葡萄球菌(11.43%)。医院感染的金黄色葡萄球菌,凝固酶阴性葡萄球菌,铜绿假单胞菌,大肠埃希菌耐药率明显高于社区感染,差异有统计学意义(P<0.01)。而肺炎克雷伯菌和不动杆菌属差异无统计学意义。结论重视细菌耐药性监测,合理使用抗生素。     

Bacterial infection as a complication of liver transplantation: epidemiology and risk factors

A retrospective survey was undertaken to characterize the epidemiology of bacterial infection in 79 patients who underwent 103 operations for orthotopic liver transplantation. Fifty-four patients (68%) developed 115 bacterial infections (1.46 episodes per patient), and seven patients died as a result of these infections. Fifty-three percent of bacterial infections occurred within 2 weeks after transplantation and were designated as early infections. The most common sites of infection were the abdomen (35 cases), the bloodstream (31 cases), and the surgical wound (19 cases). Aerobic enteric gram-negative bacilli were the predominant pathogens, and other pathogenic organisms were enterococci, staphylococci, and Pseudomonas bacteria. Logistic regression analysis identified prolonged duration of surgery (greater than or equal to 8 hours) and an elevated bilirubin level (greater than or equal to 12 mg/dL) as risk factors for early bacterial infection at any site; risk factors for abdominal or wound infection were prolonged duration of surgery, increased operative transfusion requirement (greater than or equal to 2 blood volumes), and prior hepatobiliary surgery. Awareness of the sites, pathogens, and time of onset of bacterial infection provides a basis for improved prophylaxis and empiric therapy.     

Characteristics of bacterial infections and prevalence of multidrug-resistant bacteria in hospitalized patients with liver cirrhosis in Germany

Introduction and ObjectivesBacterial infections are associated with a dismal prognosis in patients with liver cirrhosis. Data on their prevalence and the associated pathogen spectra in Germany are scarce. This study aimed to evaluate the impact of bacterial infections on mortality in hospitalized patients with liver cirrhosis and to analyze the prevalence of multidrug-resistant (MDR) bacteria in a German tertiary care center.Patients and MethodsConsecutive, non-electively hospitalized patients with liver cirrhosis were enrolled in this study between 03/2019-06/2021. All patients underwent clinical, laboratory and microbiological testing to detect potential bacterial infections. Patients were followed for 30 days regarding the composite endpoint of death or liver transplantation (mortality).ResultsIn total, 239 patients were recruited (median MELD 18). Bacterial infection was detected in 81 patients (33.9%) at study inclusion. A total of 70 patients (29.3%) developed a hospital-acquired infection. When comparing community-acquired and hospital-acquired infections, the pathogen pattern shifted from a gram-negative to a more gram-positive spectrum and showed an increase of Staphylococcus spp.. MDR bacteria were detected in seven infected patients (5.8%). 34 patients reached the composite endpoint during 30-days follow-up. In multivariable logistic regression analysis, the presence of infection during hospitalization remained independently associated with higher mortality (OR 2.522, 95% CI 1.044 - 6.091, p = 0.040).ConclusionsThis study demonstrates that bacterial infections are common in hospitalized patients with liver cirrhosis in Germany and are a major determinant of short-term mortality. Our data highlight the importance of regional differences in MDR bacteria and may guide physicians' decision-making regarding calculated antibiotic treatment.     

Influence of probiotics and fibre on the incidence of bacterial infections following major abdominal surgery - results of a prospective trial

INTRODUCTION: Early enteral nutrition with fibre and probiotics has been effective in preventing bacterial translocation and is therefore expected to reduce the incidence of postoperative bacterial infections. PATIENTS AND METHODS: In a prospective randomized trial including 172 patients following major abdominal surgery or liver transplantation, the incidence of bacterial infections was compared in patients receiving either a) conventional parenteral or enteral nutrition, b) enteral nutrition with fibre and lactobacillus plantarum 299 or c) enteral nutrition with fibre and heat inactivated lactobacilli (placebo). Liver transplant recipients were also treated with selective bowel decontamination (SBD). Routine laboratory parameters, nutritional parameters and the cellular immune status were measured preoperatively and on postoperative days 1, 5 and 10. RESULTS: Patients were comparable regarding preoperative ASA-classification, Child-Pugh classification of cirrhosis, operative data and immunosuppression. The incidence of bacterial infections after liver, gastric oder pancreas resection was 31 % in the conventional group a) compared to 4 % in the lactobacillus-group b) and 13 % in the placebo-group c). In the analysis of 95 liver transplant recipients, 13 % group b)-patients developed infections compared to 48 % group a)-patients and 34 % group c)-patients. The difference between groups a) and b) was statistically significant in both cases. In addition, the duration of antibiotic therapy was significantly shorter in the lactobacillus-group. Cholangitis and pneumonia were the most frequent infections and enterococci the most frequently isolated bacteria. Fibre and lactobacilli were well tolerated in most cases. CONCLUSION: Fibre and probiotics could lower the incidence of bacterial infections following major abdominal surgery in comparison to conventional nutrition with or without SBD. With this new concept, costs can be reduced by shortening the duration of antibiotic therapy and sparing SBD.