耐碳青霉烯类肠杆菌科细菌在肝移植患儿中定植与感染的调查分析

Translated title of the contribution: Colonization rate and infection status of carbapenems resistant enterobacteriaceae in pediatric liver transplantation recipients

Yan Sun, Lixin Yu, Yihe Liu, Jianlei Zhang, Zhongyang Shen, Wei Lu

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To explore the colonization and infection rates of carbapenems resistant enterobacteriaceae (CRE) in pediatric liver transplantation (LT) recipients and analyze the prognosis and risk factors of CRE infection. Methods: We performed a prospective cohort study of all children undergoing LT during 6-month period to define the risk factors associated with CRE infection. Anal swab bacterial cultures were performed when children entered into and discharged from intensive care unit (ICU) for screening CRE colonization. Clinical data of preoperative status and postoperative complications were collected. Liver transplant recipients were divided into CRE infection group (n=13) and non-CRE infection group (n=139). Univariate and multivariate Logistic regressions were performed to determine the independent risk factors for CRE infection and survival rates of two groups analyzed. Results: The incidence of preoperative CRE infection, preoperative cytomegalovirus (CMV) infection, preoperative sepsis, intraoperative blood loss and operative duration were significantly higher in CRE infection group than those in non-CRE infection group (P<0.005). In CRE infection group, postoperative ICU treatment time, postoperative incidence of unplanned surgery, postoperative frequency of mechanical ventilation>24-hour and CRE colonization prior to ICU were significantly higher than those in non-CRE infection group (P<0.05). No significant inter-group differences existed in vascular complications, biliary tract complications, acute rejection, drug-induced liver injury or hepatitis recurrence, etc. (P>0.05). There were 12 cases of CRE colonization in CRE infection group, including prior to ICU (n=9) and within ICU (n=3). There were 32 cases (23.0%, 32/139) of CRE colonization in non-CRE infection group, including prior to ICU (n=17) and within ICU (n=15). Logistic regression analysis indicated that the independent risk factors for CRE infection included preoperative CRE infection, CRE colonization prior to ICU and postoperative ICU treatment time. There were 4 deaths in CRE infection group and 3 deaths (2.2%, 3/139) in non-CRE infection group. Conclusions: Independent risk factors for postoperative CRE infection in pediatric liver transplant recipients include preoperative CRE infection, CRE colonization prior to ICU and postoperative ICU treatment time.CRE infection progresses rapidly with a worse prognosis and higher mortality. Anal swab CRE screening is helpful for early warning of CRE infection.

Translated title of the contributionColonization rate and infection status of carbapenems resistant enterobacteriaceae in pediatric liver transplantation recipients
Original languageChinese (Simplified)
Pages (from-to)881-888
Number of pages8
JournalChinese Journal of Pediatric Surgery
Volume41
Issue number10
DOIs
StatePublished - Oct 15 2020
Externally publishedYes

Keywords

  • Carbapenem-resistant enterobacteriaceae
  • Intestinal colonization
  • Liver transplantation

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