The Clinical Study Of Bacterial Infection Occurred After Orthotopic Liver Transplantation

Objective To investigate an effective method for prevention and treatment of postoperative bacterial infection according to retrospective analysis of the features and risk factors of bacterial infection.Methods The incidence and sites of postoperative bacterial infections as well as species and resistance of bacteria in 101 patients underwent orthotopic liver transplantation (OLT)from January 2005 to January 2008 were retrospectively analyzed. Agar diffusion method was used in identification of bacteria and susceptibility test.The bacterial infections and its potenlial risk factors were investigated. The data was analysed with chi square test in single factor analysis,p<0.05was presumed in statistics distinction.The Logistic stepwise analysis was used in multiple factor analysis,α入=0.05,α出=0.051.Results Nosocomia infection was confirmed in 45 patiens (44.6%), with 113 episodes of bacterial infection. 90 episodes of bacterial infection (79.6%) were taken place in two weeks after OLT. Respiratory tract was the most common infectious site(49.6%). The other sites were abdominal cavity(31.0%) , blood(11.5%), biliary tract(5.3%)and urinary system(2.7%).Infection of incisional wound was not occurrence in all cases.202 strains were segregated including 115(56.9%) strains of gram-negative bacterias and 87(43.1%) stains of gram-positive bacterias. Bacillus coli (23.8%) , staphylococcus aureus (20.3%) , Klebsiella pneumoniae (12.4%) , Enterobacter cloacae( 11.4%), Enterococcus (9.9%) and Staphylococcus epidermidis (9.4%) were the commonest bacteria. Meropenem,imipenem, cefepime and cefoperazone are sensitiveness to gram-negative bacterias.Ciprofloxacin,piperacillin, ampicillin were drug fast. Vancomycin, meropenem, ciprofloxacin, imipenem and oxacillin were sensitiveness to gram-postive bacterias, penicillin, erythromycin and clindamycin were drug fast. ESBLs were sensitived to imipenem and meropenem ; the vancomycin was the sensitiveness drug of MRSA and MRSE.The main risk factors include delayed restoration of gastrointestinal function, the liver function level before operation, hypoproteinemia and persistent postoperative hyperglucocemia. Perioperative decontamination of the digestive tract had a protective effect.Conclusions Bacterial infection is one of the most severe complications after OLT. Removing the risk factors, early diagnosis and treatment of the infection are very important.The bacterial infection incidence after OLT is 44.6% and most are hospital acquired infection and endogenous infection. The incidence of multiple infection and multiple-site infection is 84.4%. Gram-negative bacteria is the primary infection strain. Pulmonary infection which is prevention emphasis is often occurs, the key of prevention for bacterial infection is positive control, early diagnosis and treatment to susceptible receptor. There has no unified prevention strategy for the treatment to bacterial infection of postoperative of liver transplantation. Each transplant center should summarize by stages each characteristic of bacterial infection and risk factors in transplantation ward, and seek self-experience of prophylaxis and treatment.