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19 May 2020 : Original article  

Bacterial and Fungal Infections After Liver Transplantation: Microbial Epidemiology, Risk Factors for Infection and Death with Infection

Weili Zhang1ABCDEF, Wentao Wang2D, Mei Kang3A*, Siying Wu3B, Ya Liu3B, Quanfeng Liao3B, Yuling Xiao3A, Ying Ma3D, Yi Xie1A

DOI: 10.12659/AOT.921591

Ann Transplant 2020; 25:e921591

Abstract

BACKGROUND: Infections, especially bacterial and fungal infections, are the leading cause of high mortality after liver transplantation (LT). This research investigated the pathogenic spectrum, antimicrobial susceptibility results, and risk factors of infection and death with infection to better control such infections.

MATERIAL AND METHODS: A retrospective cohort study was performed, and 433 liver transplant recipients between January 2010 and December 2016 were analyzed.

RESULTS: We found 290 isolates of bacteria and fungi in 170 infected liver transplant patients. Significant independent risk factors for bacterial and fungal infections were prolonged hospital stay (OR 1.034, 95% CI 1.013~1.056, p=0.002), mechanical ventilation (OR 3.806, 95% CI 1.567~9.248, p=0.003), and liver failure (OR 2.659, 95% CI 1.019~6.940, p=0.046). Furthermore, postoperative MELD scores (OR 1.120, 95% CI 1.020~1.230, p=0.017) and septic shock (OR 12.000, 95% CI 1.124~128.066, p=0.003) were independent risk factors for death with infection. CRAB infection is the main pathogenic bacteria of septic shock in LT patients.

CONCLUSIONS: We found that 39.3% of recipients had at least 1 bacterial or fungal infection after LT. Shortening the length of hospital stay and early withdrawal of mechanical ventilation will reduce the risk of infection after LT. Patients with liver failure should be more vigilant against postoperative infection. Once an infection occurs, immediate assessment of the postoperative MELD score, early diagnosis of septic shock, and active search for pathogenic evidence for precise treatment will help improve patient prognosis. Routine screening for CRAB colonization before surgery will facilitate empirical use of effective antibiotics.

Keywords: Bacterial Infections, Liver Transplantation, Risk Factors, Anti-Bacterial Agents, Length of Stay, Liver Diseases, Mycoses, Postoperative Complications, Respiration, Artificial

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358