背景:肝移植(LT)是终末期肝病的唯一治愈性治疗方法。然而,LT受者容易受到感染,这是LT术后早期死亡的主要原因。血液中的肺炎克雷伯菌感染(KPI)在LT受体中很常见。我们假设KPI和耐碳青霉烯类肺炎克雷伯菌(CRKP)感染可能会影响LT受者的预后。
目的:评估KPI发生率,定时,分布,耐药性,和LT后的危险因素及其与结局的关系。
方法:这项回顾性研究包括在中南大学湘雅三医院接受LT的406例患者,三级医院,2015年1月至2023年1月。我们调查了KPI的危险因素,并使用逻辑回归分析评估了KPI和CRKP感染对LT受者预后的影响。
结果:KPI发生率为7.9%(n=32),肺部/胸腔是最常见的感染部位;从LT到KPI发作的中位时间为7.5d。在44株肺炎克雷伯菌中,43例(97.7%)和34例(77.3%)对多粘菌素B或头孢他啶/阿维巴坦和替加环素敏感,分别>70%对哌拉西林/他唑巴坦耐药,头孢他啶,头孢吡肟,氨曲南,美罗培南,和左氧氟沙星.女性[优势比(OR)=2.827,95%置信区间(CI):1.256-6.364;P=0.012],LT前期糖尿病(OR=2.794,95CI:1.070-7.294;P=0.036),LT后第1天丙氨酸转氨酶(ALT)水平≥1500U/L(OR=3.645,95CI:1.671-7.950;P=0.001),置管时间超过4d(OR=2.266,95CI:1.016-5.054;P=0.046)是KPI的危险因素。CRKP感染,但不是KPI,是LT术后6个月全因死亡率的危险因素.
结论:KPI在LT后频繁且迅速发生。危险因素包括女性,LT前期糖尿病,LT后ALT水平增加,和导尿管时间。CRKP感染,而不是KPI,影响死亡率。
BACKGROUND: Liver transplantation (LT) is the only curative treatment for end-stage liver disease. However, LT recipients are susceptible to infection, which is the leading cause of early mortality after LT. Klebsiella pneumoniae infections (KPIs) in the bloodstream are common in LT recipients. We hypothesized that KPIs and carbapenem-resistant Klebsiella pneumoniae (CRKP) infections may affect the outcomes of LT recipients.
OBJECTIVE: To assess KPI incidence, timing, distribution, drug resistance, and risk factors following LT and its association with outcomes.
METHODS: This retrospective study included 406 patients undergoing LT at The Third Xiangya Hospital of Central South University, a tertiary hospital, from January 2015 to January 2023. We investigated the risk factors for KPIs and assessed the impact of KPIs and CRKP infections on the prognosis of LT recipients using logistic regression analysis.
RESULTS: KPI incidence was 7.9% (n = 32), with lung/thoracic cavity the most frequent site of infection; the median time from LT to KPI onset was 7.5 d. Of 44 Klebsiella pneumoniae isolates, 43 (97.7%) and 34 (77.3%) were susceptible to polymyxin B or ceftazidime/avibactam and tigecycline, respectively; > 70% were resistant to piperacillin/ tazobactam, ceftazidime, cefepime, aztreonam, meropenem, and levofloxacin. Female sex [odds ratio (OR) = 2.827, 95% confidence interval (CI): 1.256-6.364; P = 0.012], pre-LT diabetes (OR = 2.794, 95%CI: 1.070-7.294; P = 0.036), day 1 post-LT alanine aminotransferase (ALT) levels ≥ 1500 U/L (OR = 3.645, 95%CI: 1.671-7.950; P = 0.001), and post-LT urethral catheter duration over 4 d (OR = 2.266, 95%CI: 1.016-5.054; P = 0.046) were risk factors for KPI. CRKP infections, but not KPIs, were risk factors for 6-month all-cause mortality post-LT.
CONCLUSIONS: KPIs occur frequently and rapidly after LT. Risk factors include female sex, pre-LT diabetes, increased post-LT ALT levels, and urethral catheter duration. CRKP infections, and not KPIs, affect mortality.