title: Multidrug resistant gram-negative bacilli as predominant bacteremic pathogens in liver transplant recipients.
abstract: BACKGROUND
  Bacteremias, which are often caused by gram-negative bacteria, are the most frequently occurring infectious complications after liver transplantation (LT). The aim of this study was to investigate bacteremic incidence, pathogenic spectrum, risk factors for bacteremia due to multidrug resistant (MDR) gram-negative bacilli, and its impact on mortality after LT.
  
  
  METHODS
  A cohort analysis of prospectively recorded data was done in 475 LT recipients, who were divided into 3 categories: cases with gram-negative bacteremia, cases with MDR gram-negative bacteremia, and cases without bacteremia as controls.
  
  
  RESULTS
  In 475 LT recipients, there were 152 (32.0%) patients with gram-negative bacillus bacteremia in the first 6 months after LT. Out of 152 patients, there were 225 bacteremic episodes, which accounted for 69.7% in a total 323 bacteremic episodes. A total of 190 bacteremic episodes were caused by Stenotrophomonas maltophilia, Enterobacteriaceae, Ochrobactrum anthropi, Pseudomonas, and Acinetobacter baumanii, all of which were the most frequent gram-negative isolates in this study, and MDR bacilli constituted 56.3%. The most frequent source was intravascular catheters. There were 70 patients with MDR gram-negative bacillus bacteremia. Independent risk factors for bacteremia due to MDR gram-negative bacillus were as follows: post-LT abdominal infection (P<0.0001, odds ratio [OR] 0.066, 95% confidence interval [CI] 0.019-0.226), post-LT reoperative episodes (P<0.0001, OR 10.505, 95% CI 3.055-36.121), or one or more episodes of acute rejection (P=0.042, OR 4.457, 95% CI 0.988-20.103). In the first 6 months after LT, MDR gram-negative bacillus bacteremia-related mortality was significantly higher than that due to antibiotic-susceptible bacillus (38.6% vs. 14.6%, P<0.001).
  
  
  CONCLUSIONS
  Post-LT bacteremias caused by MDR gram-negative bacilli are common, and associated with allograft acute rejection, post-LT reoperation, and abdominal infection. The increasing isolates of MDR gram-negative bacilli pose a great challenge for clinical treatment.
authors.affiliation: Department of Hepatobiliary Surgery, Center of Liver Transplantation, Zhejiang University, Hangzhou, China. sms3391@hotmail.com
authors.forename: S H
authors.initials: SH
authors.lastname: Shi
authors.forename: H S
authors.initials: HS
authors.lastname: Kong
authors.forename: J
authors.initials: J
authors.lastname: Xu
authors.forename: W J
authors.initials: WJ
authors.lastname: Zhang
authors.forename: C K
authors.initials: CK
authors.lastname: Jia
authors.forename: W L
authors.initials: WL
authors.lastname: Wang
authors.forename: Y
authors.initials: Y
authors.lastname: Shen
authors.forename: M
authors.initials: M
authors.lastname: Zhang
authors.forename: S S
authors.initials: SS
authors.lastname: Zheng
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D015331:Cohort Studies; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents