title: Multidrug-resistant gram-negative bacterial infections after liver transplantation - spectrum and risk factors.
abstract: OBJECTIVE
  Gram-negative bacilli infections, especially multidrug-resistant gram-negative bacilli infections, are the leading cause of high mortality after liver transplantation. This study sought to investigate the type of infection, infection rate, pathogenic spectrum, antibiotic-resistance profile, risk factors, and epidemiology of multidrug-resistant gram-negative bacterial infection.
  
  
  METHODS
  A retrospective cohort study was conducted and data of 217 liver transplant patients receiving cadaveric livers between January 2007 and April 2010 were analyzed. Antibiotic susceptibility was determined by minimum inhibitory concentration test. Extended-spectrum and metallo-β-lactamase assays were used to analyze β-lactamase-produced isolates, and repetitive-sequence polymerase chain reaction was used to differentiate bacterium subspecies.
  
  
  RESULTS
  Sixty-seven isolates of multidrug-resistant gram-negative bacteria were isolated from 66 infected liver transplant patients. Stenotrophomonas maltophilia (100%, 8/8), Klebsiella pneumoniae (61.5%, 8/13), Enterobacter cloacae (75%, 3/4) and Escherichia coli (81.3%, 13/16) were the most common extended-spectrum β-lactamase-producing bacilli. Metallo-β-lactamase expressing isolates were identified as S. maltophilia (100%, 8/8), Pseudomonas aeruginosa (83.3%, 5/6), Acinetobacter baumannii (95%, 19/20). Significant independent risk factors for multidrug-resistant gram-negative infection were extended use of pre-transplant broad-spectrum antibiotics (OR 9.027, P=0.001) and prolonged (≧72h) endotracheal intubation (OR 3.537, P=0.033).
  
  
  CONCLUSIONS
  To reduce the risk of acquiring MDR gram-negative bacillus infections after liver transplant, control measures are required to limit the use of prophylactic antibiotic in preventing infection during liver transplant and to shorten endotracheal intubation time.
authors.affiliation: Department of General Surgery, Shanghai First Peoples Hospital, Medical School of Shanghai Jiaotong University, 85 Wu Jing Road, 200080 Shanghai, People's Republic of China. zhonglin1@medmail.com.cn
authors.forename: Lin
authors.initials: L
authors.lastname: Zhong
authors.forename: Tong-Yi
authors.initials: TY
authors.lastname: Men
authors.forename: Hao
authors.initials: H
authors.lastname: Li
authors.forename: Zhi-Hai
authors.initials: ZH
authors.lastname: Peng
authors.forename: Yan
authors.initials: Y
authors.lastname: Gu
authors.forename: Xin
authors.initials: X
authors.lastname: Ding
authors.forename: Tong-Hai
authors.initials: TH
authors.lastname: Xing
authors.forename: Jun-Wei
authors.initials: JW
authors.lastname: Fan
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D015331:Cohort Studies; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D005260:Female; D005838:Genotype; D006090:Gram-Negative Bacteria / Q000145:classification* / Q000187:drug effects / Q000235:genetics; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D058889:Molecular Typing; D011183:Postoperative Complications / Q000453:epidemiology / Q000382:microbiology*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents