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논문 기본 정보

자료유형
학술저널
저자정보
저널정보
대한감염학회 Infection and Chemotherapy Infection and Chemotherapy 제45권 제3호
발행연도
2013.1
수록면
315 - 324 (10page)

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Background: Bloodstream infection (BSI) is a significant cause of morbidity and mortality in liver transplant (LT) recipients. This study aimed to investigate the epidemiology and clinical features of post-transplant BSI in LT recipients. Materials and Methods: The microbiology, frequency, and outcome of post-transplant BSI in the first year after LT were retrospectively analyzed in 222 consecutive patients who had received liver transplants at a single center between 2005 and 2011. The risk factors for post-transplant BSI and death were evaluated. Results: During a 1-year period after LT, 112 episodes of BSI occurred in 64 of the 222 patients (28.8%). A total of 135 microorganisms were isolated from 112 BSI episodes including 18 polymicrobial episodes. The median time to BSI onset ranged from 8 days for Klebsiella pneumoniae to 101 days for enterococci, and the overall median for all microorganisms was 28 days. The most frequent pathogens were Enterobacteriaceae members (32.5%), enterococci (17.8%), yeasts (14.0%), Staphylococcus aureus (10.3%), and Acinetobacter baumannii (10.3%); most of them showed resistance to major antibiotics. The major sources of BSI were biliary tract (36.2%), abdominal and/or wound (28.1%), and intravascular catheter (18.5%) infections. The independent risk factors for post-transplant BSI were biliary complications (odds ratio [OR]: 2.91, 95% confidence interval [CI]: 1.29to 6.59, P = 0.010) and longer hospitalization in the intensive care unit (OR: 1.04, 95% CI: 1.00 to 1.08, P < 0.001) after LT. BSI was an independent risk factor for death (hazard ratio [HR]: 3.92, 95% CI: 2.22 to 6.91, P < 0.001), with a poorer survival rate observed in patients with BSI than in those without BSI (1-year survival rate: 60.0% versus 89.5%, respectively, P < 0.001)after LT. The strongest predictors for death in patients with BSI were hepatocellular carcinoma (HR: 3.82, 95% CI: 1.57 to 9.32,P = 0.003), candidemia (HR: 3.71, 95% CI: 1.58 to 8.71, P = 0.003), polymicrobial bacteremia (HR: 3.18, 95% CI: 1.39 to 7.28,P = 0.006), and post-transplant hemodialysis (HR: 2.44, 95% CI: 1.02 to 5.84, P = 0.044). Conclusions: BSI was a frequent post-transplant complication, and most of the causative pathogens were multi-drug resistant. Biliary complications and BSIs resulting from biliary infection are major problems for LT recipients. The prevention of BSI and biliary complications is critical in improving prognosis in liver transplant recipients.
#Bacteremia #Bloodstream infection #Liver transplantation #Epidemiology

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참고문헌 (27)

참고문헌 신청
Klotz SA / 2007 / Polymicrobialbloodstream infections involving Candida species:analysis of patients and review of the literature / DiagnMicrobiol Infect Dis 59:401~406 google schola Waki K / 2011 / Outcome of liver transplantationfor recipients with hepatitis B and hepatitis C virus coinfection:analysis of the UNOS data / Transplantation 92:809~814 google schola Albrecht SJ / 2006 / Reemergence of gram-negative health care-associatedbloodstream infections / Arch Intern Med 166 : 1289 ~ 1294 google schola Bert F / 2010 / Microbial epidemiology and outcome ofbloodstream infections in liver transplant recipients: ananalysis of 259 episodes / Liver Transpl 16 : 393 ~ 401 google schola Choe EK / 2006 / Clinical significance of vancomycin resistant enterococcusin liver transplantation / J Korean Soc Transplant 2 : 241 ~ 247 google schola

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