Clinical Research Of The Bacterial And Fungal Infections In Early Stage After Orthotopic Liver Transplantation

Objective: To summarize clinical features of bacterial and fungal infections in early stage after liver transplantation in our hospital and to analyze the influencing factors of bacterial infection after liver transplantation and find out means of prevention and cure. Methods: With case-control study, from Jun. 2002 to Dec. 2004 the clinical data of 143 patients who underwent liver transplantation were retrospectively analyzed, including the infection rate of bacterial and fungal infections, infection site, pathogenic bacteria and drug resistance. Single factor analysis were used to analyze the influencing factors of bacterial infection after liver transplantation (T test for the numerical variable data of the Gaussian distribution, rank sum test for the numerical variable data of the nonnormal distribution, and Chi-square test for categorical variable data): statistical significance was designated at P<0.05. Logistic regression analysis was performed to determine significant independent contributor to bacterial infection.Results: The infection incidence after liver transplantation was 58.74% (84/143) for bacterial infection and 18.88%(27/143) for fungal infections.90.48% (76/84) of bacterial infection and 85.19%(23/27) of fungal infection episode occurred in one month after liver transplantation. The case fatality rate of patients with bacterial infection was higher than the control group (P=0.017<0.05) . The case fatality rate of patients with fungal infection was 59.26%. The pathogenic fungal, from high to low frequency, included Blastomyces albicans, Candida tropicalis, yeast-like fungus, Aspergillus and so on. The pathogenic bacteria, from high to low frequency, included Acinetobacter baumannii/haemolyticus, Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, Xanthomonas maltophilia , E nterococcus faecalis, Aerobacter cloacae, K lebsiella pneumoniae, Staphylococcus epidermidis and so on. Gram-positive (G+) bacteria were 147 strains (70%), Gram-negative bacteria (G-) were 63 strains (30%). Most Gram-positive (G+) bacteria were sensitive to vancomycin but resistant to most other antibiotic. 30.94% of Gram-negative (G-) bacteria of were resistant to imipenem and 33.09% of gram-negative (G-) bacteria were resistant to amikacin. Single factor analysis shoed that preoperative Child-Pugh grading, history of operation on upper abdominal region, time of operation, by-pass of operation, blood transfusion, blood reclamation, re-establishment of the biliary tract, time of the breathing machine applied, and length of stay of ICU have statistical significance. Logistic regression analysis showed that preoperative Child-Pugh grading, blood transfusion, blood reclamation and length of stay of ICU have significant independent contributor to bacterial infection. Equation of Logistic was Logit P ( 1 ) = 8.823-2.460(preoperative Child-Pugh grading)-0.001 (blood transfusion) -1.617 (blood reclamation) -0.164 (length of stay of ICU) =Conclusion: The infection incidence of bacterial infection and fungal infections after liver transplantation was very high, and most of infection occurred in one month after liver transplantation. Infection is important influencing factors of survival after liver transplantation. Preoperative Child-Pugh grading, blood transfusion, blood reclamation and length of stay of ICU have significant risk factor to bacterial infection. Strengthening peri-operative management will lower infection rate. Prompt and precise diagnosis of infection and choosing proper antibiotic therapy, it will lower mortality and to elevate the quality of living.