title: Risk factors for pneumonia caused by multidrug-resistant Gram-negative bacilli among liver recipients.
abstract: Pneumonia caused by multidrug-resistant (MDR) Gram-negative bacilli is associated with a higher mortality rate. The appropriate empiric therapy is based on the understanding of local etiology and MDR pattern. This study was to evaluate the spectrum of Gram-negative bacilli, MDR rate, risk factors and mortality in 475 liver transplantation (LT) recipients. In the first six months after LT, the incidence of bacterial pneumonia was 21.3% (101/475). The overall infectious incidence during the first post-transplant month was 80.2%. The most frequent pneumonia isolates were Enterobacteriaceae, Acinetobacter baumannii, Pseudomonas aeruginosa and Staphylococcus aureus. Gram-negative bacilli accounted for 69.6% of all pneumonia pathogens. Of the main 124 Gram-negative bacilli isolates, MDR rate was 58.9%. Four risk factors for post-LT pneumonia caused by MDR Gram-negative bacilli were LT candidates with grade II-IV encephalopathy (OR 2.275, 95%CI 1.249-4.124, p = 0.006), prolonged duration of endotracheal intubation (OR 8.224, 95%CI 4.276-15.815, p = 0.013), tracheostomy (OR 4.929, 95%CI 1.099-18.308, p = 0.027) and post-LT episode(s) of reoperations (OR 10.597, 95%CI 3.726-30.134, p < 0.001). MDR Gram-negative bacterial pneumonia-related mortality was significantly higher than that because of antibiotic-susceptible bacilli (45.6% vs. 11.4%, p = 0.010). Our data suggest that pneumonia caused by MDR Gram-negative bacilli after LT is common, and associated with the severity of underlying disease, prolonged mechanical ventilation and upper abdominal surgery.
authors.affiliation: Department of Hepatobiliary Surgery and Center of Liver Transplantation, The First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou, China. sms3391@hotmail.com
authors.forename: Shao Hua
authors.initials: SH
authors.lastname: Shi
authors.forename: Hai Shen
authors.initials: HS
authors.lastname: Kong
authors.forename: Chang Ku
authors.initials: CK
authors.lastname: Jia
authors.forename: Wen Jin
authors.initials: WJ
authors.lastname: Zhang
authors.forename: Jian
authors.initials: J
authors.lastname: Xu
authors.forename: Wei Lin
authors.initials: WL
authors.lastname: Wang
authors.forename: Yan
authors.initials: Y
authors.lastname: Shen
authors.forename: Min
authors.initials: M
authors.lastname: Zhang
authors.forename: Shu Sen
authors.initials: SS
authors.lastname: Zheng
mesh_terms: D000328:Adult; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000382:microbiology* / Q000401:mortality; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000382:microbiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate