Distribution and drug resistance of pathogenic bacteria for infection after liver transplantation
10.3969/j.issn.1001-5256.2023.06.017
- VernacularTitle:肝移植术后感染病原菌分布及耐药性分析
- Author:
Duo HAN
1
,
2
,
3
;
Hong HE
1
;
Hongwei WANG
1
;
Tingting TIAN
1
;
Jing LI
1
,
2
Author Information
1. Department of Clinical Laboratory, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266061, China
2. Department of Laboratory Medicine, Qingdao University School of Medicine, Qingdao, Shandong 266073, China
3. Department of Clinical Laboratory, The People's Hospital of Zhoucun District, Zibo, Shandong 255300, China
- Publication Type:Original Article_Other Liver Disease
- Keywords:
Liver Transplantation;
Bacterial Infections;
Drug Resistance, Bacterial
- From:
Journal of Clinical Hepatology
2023;39(6):1366-1373
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the distribution and drug resistance of pathogenic bacteria for infection after liver transplantation, and to provide a scientific basis for the rational clinical application of antibiotics. Methods The pathogenic bacteria isolated from the specimens of 904 patients with infection after liver transplantation in The Affiliated Hospital of Qingdao University from March 2014 to December 2021 were analyzed in terms of distribution and drug resistance. WHONET 5.6 software was used to perform a statistical analysis of strains and bacterial resistance rate, and Excel was used to analyze the sources of specimens, composition ratios, and distribution of pathogenic bacteria. Results A total of 2 208 non-repetitive pathogenic bacteria were isolated, mainly from the specimens of respiratory tract (31.25%), bile (22.28%), ascites (13.18%), blood (8.38%), and drainage fluid (4.62%). The top 10 pathogenic bacteria were Klebsiella pneumoniae subspecies (10.69%), Enterococcus faecium (10.42%), Escherichia coli (8.24%), Pseudomonas aeruginosa (8.24%), Staphylococcus epidermidis (8.06%), Acinetobacter baumannii (7.93%), Stenotrophomonas maltophilia (6.61%), Enterobacter cloacae (3.22%), Staphylococcus haemolyticus (3.08%), and Staphylococcus aureus (2.94%), accounting for 69.43% of the total pathogenic bacteria. Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Klebsiella pneumoniae subspecies, and Acinetobacter baumannii were the main pathogenic bacteria isolated from respiratory tract specimens; Enterococcus faecium was the main pathogenic bacterium isolated from bile, ascites, and drainage fluid specimens; Escherichia coli , Staphylococcus epidermidis , and Klebsiella pneumoniae subspecies were the main pathogenic bacteria isolated from blood specimens. Drug sensitivity data showed that Enterobacterales bacteria had a relatively high resistance rate to cephalosporins and fluoroquinolones and a resistance rate of < 10% to amikacin among aminoglycosides, with no strains resistant to tigecycline; compared with Escherichia coli , Klebsiella pneumoniae subspecies had a higher resistance rate to meropenem (14.71% vs 5.66%) and imipenem (11.35% vs 6.29%); non-fermentative bacteria had a relatively high resistance rate to carbapenems, with a resistance rate of < 10% to tigecycline and colistin. Among Gram-positive cocci, Enterococcus faecium had a resistance rate of 6.17% to vancomycin and 2.44% to quinupristin/dalfopristin, with no strains resistant to tigecycline and linezolid; Staphylococcus epidermidis had a resistance rate of > 50% to macrolides, fluoroquinolones, sulfonamides, and lincomycin, and a small part of these strains were resistant to linezolid and quinupristin/dalfopristin (< 3%), with no Staphylococcus epidermidis strains resistant to tigecycline and vancomycin. A total of 287 drug-resistant strains were monitored, accounting for 13%, among which there were 128 carbapenem-resistant Acinetobacter baumannii strains, 88 carbapenem-resistant Pseudomonas aeruginosa strains, 26 carbapenem-resistant Klebsiella pneumoniae subspecies strains, 11 carbapenem-resistant Escherichia coli strains, 23 methicillin-resistant Staphylococcus aureus strains, and 11 vancomycin-resistant Enterococcus strains. The carbapenem-resistant Klebsiella pneumoniae subspecies strains mainly produced serine carbapenemase, and the carbapenem-resistant Escherichia coli strains mainly produced metal β-lactamase. Conclusion Gram-negative bacteria are the main pathogenic bacteria for infection after liver transplantation, and there are differences in the distribution of pathogenic bacteria between different types of specimens. The resistance rate of some strains tend to increase, and therefore, it is necessary to strengthen the management of nosocomial infection and antibiotics.
