肝移植术后多重耐药菌感染危险因素的单中心临床研究

目的  分析肝移植术后发生多重耐药菌（MDRO）感染的危险因素。方法  回顾性分析77例肝移植受者的临床资料，根据是否发生MDRO感染分为非MDRO感染组（51例）及MDRO感染组（26例）。总结肝移植受者术后MDRO的感染率和菌株分布情况；分析肝移植受者术后发生MDRO感染的危险因素；比较两组受者的预后情况。结果  肝移植术后MDRO感染率为34%（26/77），主要为耐碳青霉烯类MDRO感染，主要感染部位为肺部、腹腔和切口。单因素分析提示术后气管插管≥48 h、重症监护室（ICU）入住时间≥72 h、住院时间≥30 d、再次手术、持续性肾脏替代治疗（CRRT）和他克莫司（Tac）血药浓度≥15 ng/mL是肝移植术后发生MDRO感染的危险因素。Cox回归分析提示术后气管插管≥48 h、再次手术、CRRT和Tac血药浓度≥15 ng/mL是肝移植术后发生MDRO感染的独立危险因素。MDRO感染组病死率高于非MDRO感染组[31%（8/26）比10%（5/51），P=0.01]。结论  术后气管插管≥48 h、再次手术、CRRT和Tac血药浓度≥15 ng/mL会增加肝移植术后MDRO感染的风险，影响受者的预后。

Risk factors of multi-drug resistant organism infection after liver transplantation: a single-center clinical trial

Objective To analyze the risk factors of multi-drug resistant organism (MDRO) infection after liver transplantation. Methods The clinical data of 77 recipients undergoing liver transplantation were retrospectively analyzed. According to the incidence of MDRO infection, all recipients were divided into the non-MDRO infection group (n=51) and MDRO infection group (n=26). The infection rate and strain distribution of MDRO in liver transplant recipients were summarized. The risk factors of MDRO infection in liver transplant recipients were identified. Clinical prognosis of all recipients was statistically compared between two groups. Results The infection rate of MDRO after liver transplantation was 34% (26/77), mainly carbapenem-resistant MDRO infection. The main sites of infection included lung, abdominal cavity and incision. Univariate analysis showed that postoperative tracheal intubation ≥48 h, length of intensive care unit (ICU) stay ≥72 h, length of hospital stay ≥30 d, re-operation, continuous renal replacement therapy (CRRT) and tacrolimus (Tac) blood concentration ≥15 ng/mL were the risk factors for MDRO infection after liver transplantation. Cox regression analysis indicated that postoperative tracheal intubation≥48 h, re-operation, CRRT and Tac blood concentration ≥15 ng/mL were the independent risk factors for MDRO infection after liver transplantation. The fatality in the MDRO infection group was significantly higher than that in the non-MDRO infection group [31%(8/26) vs. 10%(5/51), P=0.01]. Conclusions Postoperative tracheal intubation ≥48 h, re-operation, CRRT and Tac blood concentration ≥15 ng/mL may increase the risk of MDRO infection after liver transplantation and affect clinical prognosis of the recipients.