Multidrug-resistant bacterial infections after liver transplantation: Prevalence, impact, and risk factors.

Autor: Martin-Mateos R; Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Madrid. Universidad de Alcalá, Madrid, España; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto Salud Carlos III, Madrid, España., Martínez-Arenas L; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto Salud Carlos III, Madrid, España; Hepatology, Hepatobiliopancreatic Surgery and Transplant Group, IIS La Fe Health Research Institute, HUP La Fe, Valencia, España; Department of Biotechnology, Universitat Politècnica de València, Valencia, Spain., Carvalho-Gomes Á; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto Salud Carlos III, Madrid, España; Hepatology, Hepatobiliopancreatic Surgery and Transplant Group, IIS La Fe Health Research Institute, HUP La Fe, Valencia, España., Aceituno L; Liver Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, España., Cadahía V; Liver Unit, Division of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain., Salcedo M; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto Salud Carlos III, Madrid, España; Liver Unit, Gastroenterology Department, Hospital Universitario Gregorio Marañón, Universidad Complutense, Madrid, España., Arias A; Unidad de Trasplante Hepático, Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España., Lorente S; Unidad de Hepatología y Trasplante Hepático, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), España., Odriozola A; Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Santander, Spain., Zamora J; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto Salud Carlos III, Madrid, España; Reina Sofía University Hospital, Hepatology and Liver Transplantation, IMIBIC, Córdoba, España., Blanes M; Infectious Diseases Department, Hospital La Fe, Valencia, España., Len Ó; Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERInfec), Instituto Salud Carlos III, Madrid, España; Department of Medicine, Universidad Autónoma, Barcelona, España., Benítez L; Unidad de Trasplante Hepático, Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España., Campos-Varela I; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto Salud Carlos III, Madrid, España; Liver Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, España; Department of Medicine, Universidad Autónoma, Barcelona, España., González-Diéguez ML; Liver Unit, Division of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain., Lázaro DR; Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Madrid. Universidad de Alcalá, Madrid, España; Liver Section, Gastroenterology Department, Department of Medicine, Hospital del Mar, Barcelona, Spain., Fortún J; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERInfec), Instituto Salud Carlos III, Madrid, España; Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Madrid. Universidad de Alcalá, Madrid, España., Cuadrado A; Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Santander, Spain., Carrasco NM; Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Madrid. Universidad de Alcalá, Madrid, España., Rodríguez-Perálvarez M; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto Salud Carlos III, Madrid, España; Reina Sofía University Hospital, Hepatology and Liver Transplantation, IMIBIC, Córdoba, España., Álvarez-Navascues C; Liver Unit, Division of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain., Fábrega E; Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Santander, Spain., Serrano T; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto Salud Carlos III, Madrid, España; Unidad de Hepatología y Trasplante Hepático, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), España., Cuervas-Mons V; Unidad de Trasplante Hepático, Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España; Universidad Autónoma Madrid, Medicina, Madrid, Spain., Rodríguez M; Liver Unit, Division of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain; University of Oviedo, Spain., Castells L; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto Salud Carlos III, Madrid, España; Liver Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, España; Department of Medicine, Universidad Autónoma, Barcelona, España., Berenguer M; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto Salud Carlos III, Madrid, España; Hepatology, Hepatobiliopancreatic Surgery and Transplant Group, IIS La Fe Health Research Institute, HUP La Fe, Valencia, España; Department of Medicine, Universidad de Valencia, Valencia, Spain., Graus J; Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Madrid. Universidad de Alcalá, Madrid, España., Albillos A; Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Madrid. Universidad de Alcalá, Madrid, España; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto Salud Carlos III, Madrid, España. Electronic address: agustin.albillos@uah.es.
Jazyk: angličtina
Zdroj: Journal of hepatology [J Hepatol] 2024 Jun; Vol. 80 (6), pp. 904-912. Date of Electronic Publication: 2024 Feb 28.
DOI: 10.1016/j.jhep.2024.02.023
Abstrakt: Background & Aims: Infections by multidrug-resistant bacteria (MDRB) are an increasing healthcare problem worldwide. This study analyzes the incidence, burden, and risk factors associated with MDRB infections after liver transplant(ation) (LT).
Methods: This retrospective, multicenter cohort study included adult patients who underwent LT between January 2017 and January 2020. Risk factors related to pre-LT disease, surgical procedure, and postoperative stay were analyzed. Multivariate logistic regression analysis was performed to identify independent predictors of MDRB infections within the first 90 days after LT.
Results: We included 1,045 LT procedures (960 patients) performed at nine centers across Spain. The mean age of our cohort was 56.8 ± 9.3 years; 75.4% (n = 782) were male. Alcohol-related liver disease was the most prevalent underlying etiology (43.2.%, n = 451). Bacterial infections occurred in 432 patients (41.3%) who presented with a total of 679 episodes of infection (respiratory infections, 19.3%; urinary tract infections, 18.5%; bacteremia, 13.2% and cholangitis 11%, among others). MDRB were isolated in 227 LT cases (21.7%) (348 episodes). Enterococcus faecium (22.1%), Escherichia coli (18.4%), and Pseudomonas aeruginosa (15.2%) were the most frequently isolated microorganisms. In multivariate analysis, previous intensive care unit admission (0-3 months before LT), previous MDRB infections (0-3 months before LT), and an increasing number of packed red blood cell units transfused during surgery were identified as independent predictors of MDRB infections. Mortality at 30, 90, 180, and 365 days was significantly higher in patients with MDRB isolates.
Conclusion: MDRB infections are highly prevalent after LT and have a significant impact on prognosis. Enterococcus faecium is the most frequently isolated multi-resistant microorganism. New pharmacological and surveillance strategies aimed at preventing MDRB infections after LT should be considered for patients with risk factors.
Impact and Implications: Multidrug-resistant bacterial infections have a deep impact on morbidity and mortality after liver transplantation. Strategies aimed at improving prophylaxis, early identification, and empirical treatment are paramount. Our study unveiled the prevalence and main risk factors associated with these infections, and demonstrated that gram-positive bacteria, particularly Enterococcus faecium, are frequent in this clinical scenario. These findings provide valuable insights for the development of prophylactic and empirical antibiotic treatment protocols after liver transplantation.
(Copyright © 2024 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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