OBJECTIVES: Liver transplant recipients have a high rate of postoperative infection, and identification of patients at high risk for bacterial and fungal infections will help prevent disease and improve long-term outcomes for them. This study aims to understand the composition, distribution, prognosis of bacterial and fungal infections within 2 months after liver transplantation and to analyze their risk factors. METHODS: The data of pathogen composition, distribution, and prognosis of bacterial and fungal infections among liver transplant recipients in the Third Xiangya Hospital of Central South University from May 2020 to October 2021 were collected, and the risk factors for these infections were analyzed. RESULTS: A total of 106 episodes of bacterial or fungal infections occurred in 71.4% of liver transplant recipients (75/105). Gram-negative bacteria were the dominant pathogenic bacteria (49/106, 46.2%), followed by Gram-positive bacteria (31/106, 29.2%). The most common Gram-negative bacterium was Acinetobacter baumannii (13/106, 12.3%). The most common Gram-positive bacterium was Enterococcus faecium (20/106, 18.9%). The most common infections were pulmonary (38/105, 36.2%) and multiple site infections (30/105, 28.6%). Six (6/105, 5.7%) patients with infections died within 2 months after liver transplantation. Univariate analysis showed that the model for end-stage liver disease (MELD) score ≥25, antibiotic use within half a month before transplantation, infections within 2 months prior to transplantation, intraoperative red blood cell infusion≥8 U, indwelling urinary tract catheter ≥4 days after transplantation, and the dosage of basiliximab use ≥40 mg were associated with infections. Multivariate logistic regression analysis revealed that only infections within 2 months prior to transplantation (OR=5.172, 95% CI 1.905-14.039, P<0.01) was an independent risk factor for bacterial and fungal infections after liver transplantation. Postoperative bacterial and fungal infections were reduced in liver transplant recipients receiving basiliximab ≥40 mg (OR=0.197, 95% CI: 0.051-0.762, P<0.05). CONCLUSIONS The incidence of bacterial and fungal infections is high in the early stage after liver transplantation, and the mortality after infection is significantly higher than that of non-infected patients. The most common infection is respiratory infection, and the dominant pathogens is Gram-negative bacteria. Patients infected within 2 months prior to liver transplantation are prone to bacterial and fungal infections. Standard use of basiliximab can reduce the incidence of infections after liver transplantation.
Bacteria ; Bacterial Infections/etiology* ; Basiliximab ; Communicable Diseases ; End Stage Liver Disease ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Humans ; Liver Transplantation/adverse effects* ; Mycoses/etiology* ; Risk Factors ; Severity of Illness Index

OBJECTIVETo analyze the condition of early (≤ 30 d) postoperative pulmonary infection in children after living donor liver transplantation (LDLT).

METHODThe clinical data of 36 cases undergoing LDLT in Children's Hospital of Chongqing Medical University were analyzed retrospectively from June 2006 to December 2009.

RESULTOf 36 cases without preoperative respiratory disease, 17 were boys, 19 were girls. Their age ranged from 2 months to 14 years. Pulmonary infection developed in 24 patients, of whom 4 cases died (17%) and 3 deaths were related to pulmonary infection. Pulmonary infection occurred in 17 of 20 infants (85%) and 10 of 11 cases (91%) with liver function of Child-Pugh grade C. Twenty cases (83%) developed pulmonary infection within first 2 weeks after LDLT. Totally 65 pathogenic strains of microorganisms were isolated, in which Gram-negative bacteria, Gram-positive bacteria and fungi were 46 strains, 5 strains, 14 strains respectively. The most frequently isolated bacteria were Pseudomonas aeruginosa (14 strains), Klebsiella pneumoniae (8 strains) and Acinetobacter baumannii (8 strains). Pseudomonas aeruginosa showed a resistance rate of almost 100% to cotrimoxazole, tetracycline, chloramphenicol, ampicillin, the first, the second and some of the third generation cephalosporins. Klebsiella pneumoniae producing extended spectrum beta-lactamase had a resistance rate of almost 100% to beta-lactams except carbapenems. Acinetobacter baumannii was exquisitely susceptible to carbapenems, but showed a high resistance to penicillins and cephalosporins. Candida albicans, which was the most common fungus, showed a susceptibility rate of 100% to amphotericin B. In the LDLT recipients of pulmonary infection, cytomegalovirus (CMV) infections occurred in 2 patients and Epstein Barr virus (EBV) infection in 1 patient.

CONCLUSIONThe incidence of early postoperative pulmonary infection was high in children undergoing LDLT, especially in infants. And the mortality should not be ignored. The high risk period for infection was within the first 2 weeks after operation. The pathogens were mainly Gram-negative bacteria, which showed high and multidrug resistance.

Adolescent ; Anti-Bacterial Agents ; therapeutic use ; Antifungal Agents ; therapeutic use ; Bacterial Infections ; drug therapy ; etiology ; microbiology ; Child ; Child, Preschool ; Drug Resistance, Bacterial ; Female ; Gram-Negative Bacteria ; drug effects ; isolation & purification ; Gram-Positive Bacteria ; drug effects ; isolation & purification ; Humans ; Infant ; Liver Transplantation ; Living Donors ; Lung Diseases ; drug therapy ; etiology ; microbiology ; Male ; Postoperative Complications ; drug therapy ; epidemiology ; etiology ; Retrospective Studies ; Risk Factors

Achromobacter denitrificans ; Adult ; Gram-Negative Bacterial Infections ; complications ; Humans ; Jaundice, Obstructive ; etiology ; Liver Abscess ; microbiology ; Male

OBJECTIVE: To investigate the possible risk factors for death among liver or kidney recipients with bloodstream infections (BSIs). METHODS: A retrospective study of 138 episodes of bloodstream infections documented in 103 patients was conducted to assess potential risk factors for mortality. The risk factors were identified by logistic regression analysis. RESULTS: The mean age of the patients was 12-66 (42.3±12.7) years. The majority of infections were nosocomial (78.6%). The BSIs-related mortality rate was 39.8% (41/103). The following variables were identified as risk factors for BSIs-related mortality by univariate analysis: intraabdominal/ biliary focus (P=0.003), polymicrobial infection (P<0.001), liver transplant (P<0.001), platelet count <50000/mm3 (P<0.001), and septic shock (P<0.001). Platelet count < 50000/mm3 (P=0.002) and septic shock (P<0.001) showed significantly difference between the mortality group and the survival groups in the multivariate logistic regression analysis. CONCLUSION Decreased platelet count and septic shock are risk factors for increased
Adolescent ; Adult ; Aged ; Bacteremia ; epidemiology ; etiology ; mortality ; Cause of Death ; Child ; China ; epidemiology ; Female ; Gram-Negative Bacterial Infections ; epidemiology ; etiology ; mortality ; Humans ; Kidney Transplantation ; adverse effects ; Liver Transplantation ; adverse effects ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Shock, Septic ; epidemiology ; Thrombocytopenia ; epidemiology ; Young Adult

Aged ; Aged, 80 and over ; Anthracosis ; complications ; microbiology ; Drug Resistance, Bacterial ; Gram-Negative Bacteria ; isolation & purification ; Gram-Negative Bacterial Infections ; complications ; Humans ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive ; etiology ; microbiology

OBJECTIVETo analyze the characteristic of bacterial infections, and the relationship between antibiotics treatment and bacterial infections after liver transplantation, and to prevent antibiotic-resistant bacterial infections.

METHODS86 liver transplant recipients were retrospected. Different indexes including limited daily dose, the frequency of medication, drug use index were used to evaluate the rationality of the use of antibiotics, three-dimensional test was used to explore extended-spectrum beta-lactamase and AmpC enzyme of Gram-negative bacteria.

RESULTSThe major pathogens of infection after liver transplantation were Enterococcus faecalis, Enterobacter cloacae, fungi and E. coli. Pre-operative antibiotic utilization rate was 83.7%, it was mainly a single use of antibiotics; After- operative antibiotic usage was 100.0%, it was mainly joint use of two or three antibiotics; The top 3 antibiotics used were cephalosporins, the combined enzyme inhibitors and penicillin. Antibiotics with drug utilization index (DUI) more than 1.1 included ampicillin and Lalin proxy. 43.3% and 31.8% of Gram -Negative bacteria produced ESBLs and AmpC, respectively, while 21.3% Gram -Negative bacteria produced two enzymes.

CONCLUSIONThere is high incidence of bacterial infections after liver transplantation. The use of antibiotics is high dose, high-frequency and reasonable; High resistance of bacterial infections was prone to develop and the prevention of the high resistance of bacterial infections is very important.

Adolescent ; Adult ; Aged ; Anti-Bacterial Agents ; administration & dosage ; therapeutic use ; Bacterial Infections ; drug therapy ; etiology ; microbiology ; Child ; Child, Preschool ; Drug Resistance, Bacterial ; Female ; Gram-Negative Bacteria ; drug effects ; enzymology ; isolation & purification ; Gram-Positive Bacteria ; drug effects ; enzymology ; isolation & purification ; Humans ; Infant ; Liver Transplantation ; adverse effects ; methods ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Postoperative Complications ; drug therapy ; epidemiology ; microbiology ; Retrospective Studies ; Young Adult ; beta-Lactamases ; biosynthesis

INTRODUCTIONImipenem and meropenem are treatment of choice for extended-spectrum betalactamase (ESBL)-positive gram-negative bacteraemia. They may select for carbapenemresistant Acinetobacter baumannii and Pseudomonas aeruginosa; ertapenem may not do so as it is inactive against these bacteria. Clinical efficacy of ertapenem in ESBL-producing gramnegative bacteraemia is limited.

MATERIALS AND METHODSRetrospective study of patients with ESBL-positive gram-negative bacteraemia treated with ertapenem was undertaken.

RESULTSForty-seven patients with multidrug-resistant gram-negative bacteraemia (79% produced ESBL) were treated with ertapenem for a median duration of 11 days. The median age was 70 years. Septic shock occurred in 19% and mechanical ventilation was needed in 17%. Klebsiella pneumoniae comprised 53% and Escherichia coli 26%. Urinary infection accounted for 61% and hepatobiliary 15%. Favourable clinical response occurred in 96%. Attributable mortality was 4%.

CONCLUSIONErtapenem is promising in culture-guided step-down therapy of ESBL-positive gram-negative bacteraemia.

Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents ; pharmacology ; therapeutic use ; Bacteremia ; drug therapy ; etiology ; Drug Resistance, Multiple, Bacterial ; Escherichia coli ; drug effects ; enzymology ; Escherichia coli Infections ; drug therapy ; microbiology ; Female ; Gram-Negative Bacteria ; drug effects ; enzymology ; Gram-Negative Bacterial Infections ; drug therapy ; microbiology ; Humans ; Klebsiella Infections ; drug therapy ; microbiology ; Klebsiella pneumoniae ; drug effects ; enzymology ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Retrospective Studies ; Urinary Tract Infections ; complications ; drug therapy ; beta-Lactamases ; biosynthesis ; beta-Lactams ; pharmacology ; therapeutic use

Cervical spinal epidural abscess, caused by fish bone injury and a secondary infection by Eikenella corrodens which is part of the normal flora, has not been reported. A 72-yr-old man came to the hospital with pain in his posterior neck and both shoulders for 2 months. He also was experiencing weakness on his right side for 3 days. A fish bone had been stuck in his throat for about 2 months. Neurological examination revealed right hemiparesis, hypesthesia on the left extremities and neck stiffness. Laboratory findings showed an elevated ESR/CRP and leukocytosis, and magnetic resonance imaging revealed a retropharyngeal abscess and cervical myelitis. The patient was treated with emergency surgical decompression and antibiotics. A fish bone was removed from the C3-C4 intervertebral disc space. In the culture of chocolate blood agar and 5% sheep blood agar plate, E. corrodens was detected as a causative organism.
Male ; Humans ; Gram-Negative Bacterial Infections/diagnosis/*etiology/prevention & control ; Foreign Bodies/*complications/*surgery ; Food/*adverse effects ; Fishes ; Epidural Abscess/diagnosis/*etiology/*surgery ; Eikenella corrodens/*isolation & purification ; Decompression, Surgical ; Bone and Bones ; Anti-Bacterial Agents/administration & dosage ; Animals ; Aged

OBJECTIVEMechanical ventilation support is a very important method for the salvage of serious patients. However, it can result in the formation of an adherent matrix of bacteria on the surfaces of implanted materials which is termed "biofilm". Biofilm is dense bacterial communities attached to a solid surface and surrounded by an exopolysaccharide matrix. One of the most important features of bacterial biofilm is their resistance to antimicrobial agents and host immune system components. As a consequence, diseases involving biofilm are generally chronic and difficult to treat. The present study was conducted to explore the relationship between ETT-biofilm and the lower respiratory infection by observing microbial colonization and associated biofilm accumulation on the surface of endotracheal tubes (ETTs) removed from neonates treated with intubated mechanical ventilation.

METHODSTwenty neonates undergoing mechanical ventilation (from January to June in 2005) were recruited into this study. Clinical data about lower respiratory infection for each case were collected. ETTs were collected at the first time of extubation. A sterile control tube was also processed. For each ETT, a 1-cm-long cross-sectional segment was divided into two portions for both scanning electron microscopy (SEM) and aerobic/anaerobic cultures. The presence of biofilm on the surface of ETTs were examined by SEM, meanwhile, bacteria harvested from the surface of ETTs and the secretions of lower respiratory tract were isolated, identified and assessed on antimicrobial susceptibility, respectively.

RESULTSThe diagnosis on admission of the twenty cases included: neonatal respiratory distress syndrome (10), meconium aspirate syndrome (2), severe asphyxia (2), pneumatothorax (2), severe pneumonia (1), scleredema neonatorum (1), inborn pulmonary hypoplasia (1) and recurrent apnea (1). Thirteen cases did not present symptoms and signs of lower respiratory infection before mechanical ventilation. However, during the mechanical ventilation process, symptoms and signs of lower respiratory infection presented and lasted until extubation. Nine of the above mentioned thirteen cases (70%) had the same duration of tube use as mechanical ventilation duration (mean: 3.6 days). Observation by SEM showed that colonization was time dependent and the incidence of microbial colonization increased when the duration of tube use exceeded one days (12/20). There were no obvious bacterial colonies except that some amorphous material was noted in 5 of 20 ETTs as early as one day of tube use. Up to 2 days of tube use (4/20), attached bacterial colonization was seen embedded in amorphous material (3/4). Up to 3 days (7/20), a layer of biofilm formation presented on ETTs (5/7). Furthermore, biofilm architecture became more mature and complex if the duration exceeded 3 days. Neither bacteria nor biofilm formation was seen on the control ETT. The results of aerobic/anaerobic cultures showed that there were 14 cultures from ETTs (normal flora grew in 4) and 7 pathogens were isolated; 13 cultures from the secretions of lower respiratory tract (normal flora grew in 1) and 10 pathogens were isolated. Seven samples had the same pathogen both on the surface of ETTs and in the secretions of lower respiratory tract, which accounted for 50% of the positive cultures from ETTs, including Xanthomonas maltophilia (2), Klebsiella pneumoniae (2), Acinetobacter lwoffii (1), Acinetobacter baumannii (1) and normal flora (1). The gram-negative bacteria isolated from the surface of ETTs and the secretions of lower respiratory tract presented multi-resistance to antibiotics.

CONCLUSIONSThe ETT-biofilm develops into mature and complex form with the duration of tube use increase. This study provides evidence that there is correlation between microbial colonization, biofilm formation on the surface of ETTs and the lower respiratory infection in neonates who were intubated and ventilated for a prolonged period. ETT-Biofilm could also be a possible source of the recurrent infection. Increased attention must be paid to modification of the ETT to prevent or substantially reduce biofilm formation.

Acinetobacter baumannii ; isolation & purification ; Anti-Bacterial Agents ; adverse effects ; therapeutic use ; Biofilms ; Colony Count, Microbial ; Equipment Contamination ; Female ; Gram-Negative Bacteria ; Humans ; Infant ; Infant, Newborn ; Intubation, Intratracheal ; adverse effects ; Male ; Microscopy, Electron, Scanning ; methods ; Pediatrics ; Pneumonia ; drug therapy ; etiology ; Respiration, Artificial ; adverse effects ; Respiratory Tract Infections ; drug therapy ; etiology ; Trachea ; microbiology

OBJECTIVETo find out the epidemiology of bacteria infection after orthotopic liver transplantation (OLT).

METHODPostoperative bacteria infection of 451 OLT cases were retrospectively analyzed.

RESULTBacteria infection were detected in 239 OLT cases, and the infection rate was 52.9%. Sum up to 304 bacilli lines were separated from all above cases. Among them, the detectable Gram-positive bacilli (G(+)) accounted for 59.9% (182/304), while Gram-negative bacilli (G(-)) accounted for 40.2% (122/304). The impressionable organ were respiratory tract and bile duct, which occupying 81.5% (248/304) and 15.1% (46/304) among all infective cases respectively. The main infected strain were G(+) bacteria in respiratory tract, account for 65.3%; while G(-) bacteria were mainly in bile duct, account for 60.9%. There was significant difference between each other (P = 0.018).

CONCLUSIONSThe bacteria infection rate was high after OLT, and the main infected strain was the G(+) bacteria. Most fo them were the opportunistic pathogenic bacteria and the antibiotic multi-resistant bacteria. The bacteria category was significantly related to the infected tissue, according to which we could adopt corresponding antibacterial approach.

Adolescent ; Adult ; Aged ; Bacterial Infections ; etiology ; microbiology ; Bile Duct Diseases ; etiology ; microbiology ; Child ; Child, Preschool ; Female ; Gram-Negative Bacteria ; isolation & purification ; Gram-Positive Bacteria ; isolation & purification ; Humans ; Infant ; Liver Transplantation ; adverse effects ; Male ; Middle Aged ; Postoperative Complications ; Respiratory Tract Infections ; etiology ; microbiology ; Retrospective Studies