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  • 1 Debreceni Egyetem, Általános Orvostudományi Kar, Debrecen, Móricz Zs. krt. 22., 4032
  • 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Budapest
  • 3 Debreceni Egyetem, Általános Orvostudományi Kar, Debrecen
Open access

Absztrakt

Bevezetés: A szerzők a májátültetést követően kialakult mikrobás fertőzéseket, a mintavételek eredményeit, a multidrug-rezisztencia incidenciáját vizsgálták a hazai betegek körében. Célkitűzés: Tanulmányozták a bakteriális fertőzés kialakulásának kockázati tényezőit, az infekciókhoz kapcsolódó szövődmények előfordulását, lefolyását, és részletes kórokozó-spektrumelemzést végeztek. Módszer: 2003–2012 között májátültetett 408 beteg adatait (281 bakteriológiai tenyésztést) vizsgálták. Eredmények: A 408 beteg közül 70 betegnél (17%) észleltek klinikai tünetekkel járó fertőzést. A tenyésztési lelet 58 betegnél (14,2%) pozitív, 12 betegnél (2,9%) negatív volt. Hét esetben (12,1%) alakult ki cholangitis, 17 esetben (29,3%) fordult elő hasűri és 28 esetben (48,3%) pulmonalis eredetű fertőzés. Posztoperatív fertőzés gyakrabban lépett fel kezdeti csökkent graftműködés, akut veseelégtelenség, epeúti szövődmény és hasűri vérzés mellett. Infekció kialakulása esetén az 1, 3 és 5 éves betegtúlélés 70%, 56% és 56% volt, míg infekció nélkül ez 94%, 87%, 85% volt (p<0,001). A kitenyészett baktériumok 56%-ánál találtak multidrug-rezisztenciát, viszont nem volt szignifikáns különbség a multidrug-rezisztencia pozitív és negatív baktériummal fertőzött csoportok egyéves betegtúlélése között (70,2% mindkettő). Következtetések: Az infekciókontroll, a multidrug-rezisztens kórokozók menedzselése a preventív, higiéniai, izolációs elvek kialakítását, betartását, valamint műtéttechnikai, transzfúziós, antibiotikus stratégiák, folyamatok fejlesztését kell, hogy megcélozza, szakmai csapatmunka keretén belül. Orv. Hetil., 2015, 156(34), 1366–1382.

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  • 1

    Starzl, T. E.: Experience in hepatic transplantation. WB Saunders, Philadelphia, 1969.

  • 2

    Calne, R. Y., William, R.: Liver transplantations in man. I. Observations on technique and organization in five cases. Br. Med. J., 1968, 4(5630), 535–540.

  • 3

    Adam, R., Karam, V., Delvart, V., et al.: Evolution of indications and results of liver transplantation in Europe. A report from the European Liver Transplant Registry (ELTR). J. Hepatol., 2012, 57(3), 675–688.

  • 4

    Nemes, B., Sárváry, E., Kóbori, L., et al.: The demographic, perioperative and mortality characteristics of the Hungarian Liver Transplant Program. [A hazai májátültetés demográfiája, perioperatív jellemzői és mortalitása.] Orv. Hetil., 2005, 146(27), 1423–1432. [Hungarian]

  • 5

    Nemes, B., Kóbori, L., Gálffy, Z., et al.: Clinical factors in association with the complications and the outcome of liver transplantation. The Hungarian experience. [A májátültetés szövődményeit és túlélési eredményeit befolyásoló tényezők Magyarországon.] Orv. Hetil., 2005, 146(30), 1567–1574. [Hungarian]

  • 6

    Patonai, A., Nemes, B., Görög, D., et al.: Pathologic evaluation of orthotopic liver transplantation in Hungary. [A hazai májtranszplantációk értékelése pathologiai szempontból (összefoglaló tanulmány).] Orv. Hetil., 2001, 142(9), 435–441. [Hungarian]

  • 7

    Alqahtani, S. A.: Update in liver transplantation. Curr. Opin. Gastroenterol., 2012, 28(3), 230–238.

  • 8

    Giamarellou, H.: Multidrug-resistant Gram-negative bacteria: how to treat and for how long. Int. J. Antimicrob. Agents, 2010, 36(Suppl. 2), S50–S54.

  • 9

    Kawecki, D., Chmura, A., Pacholczyk, M., et al.: Etiological agents of bacteremia in the early period after liver transplantation. Transplant. Proc., 2007, 39(9), 2816–2821.

  • 10

    Morata, L., Cobos-Trigueros, N., Martínez, J. A., et al.: Influence of multidrug resistance and appropriate empirical therapy on the 30-day mortality rate of Pseudomonas aeruginosa bacteremia. Antimicrob. Agents Chemother., 2012, 56(9), 4833–4837.

  • 11

    Safdar, N., Said, A., Lucey, M. R.: The role of selective digestive decontamination for reducing infection in patients undergoing liver transplantation: a systematic review and meta-analysis. Liver Transpl., 2004, 10(7), 817–827.

  • 12

    Levy, M. M., Fink, M. P., Marshall, J. C., et al.: 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit. Care Med., 2003, 31(4), 1250–1256.

  • 13

    De Smet, A. M., Kluytmans, J. A., Cooper, B. S., et al.: Decontamination of the digestive tract and oropharynx in ICU patients. N. Engl. J. Med., 2009, 360(1), 20–31.

  • 14

    Karapanagiotou, A., Kydona, C., Papadopoulos, S., et al.: Infections after orthotopic liver transplantation in the intensive care unit. Transplant. Proc., 2012, 44(9), 2748–2750.

  • 15

    United Network for Organ Sharing. Data and reports. 2011. http://www.unos.org

  • 16

    Karvellas, C. J., McPhail, M., Pink, F., et al.: Bloodstream infection after elective liver transplantation is associated with increased mortality in patients with cirrhosis. J. Crit. Care, 2011, 26(5), 468–474.

  • 17

    Zhong, L., Men, T. Y, Li, H., et al.: Multidrug-resistant gram-negative bacterial infections after liver transplantation. Spectrum and risk factors. J. Infect., 2012, 64(3), 299–310.

  • 18

    Goldaracena, N., Méndez, P., Quiñonez, E., et al.: Liver transplantation without perioperative transfusions. Single-center experience showing better early outcome and shorter hospital stay. J. Transplant., 2013, 2013, ID 649209.

  • 19

    Avkan-Oguz, V., Ozkardesler, S., Unek, T., et al.: Risk factors for early bacterial infections in liver transplantation. Transplant. Proc., 2013, 45(3), 993–997.

  • 20

    Giunta, V., Ferrer, M., Esperatti, M., et al.: ICU-acquired pneumonia with or without etiologic diagnosis: a comparison of outcomes. Crit. Care Med., 2013, 41(9), 2133–2143.

  • 21

    Safdar, N., Said, A., Lucey, M. R.: The role of selective digestive decontamination for reducing infection in patients undergoing liver transplantation: a systematic review and meta-analysis. Liver Transpl., 2004, 10(7), 817–827.

  • 22

    Wiesner, R. H., Hermans, P. E., Rakela, J., et al.: Selective bowel decontamination to decrease gram-negative aerobic bacterial and Candida colonization and prevent infection after orthotopic liver transplantation. Transplantation, 1988, 45(3), 570–574.

  • 23

    Leone, M., Albanese, J., Antonini, F., et al.: Long-term (6-year) effect of selective digestive decontamination on antimicrobial resistance in intensive care, multiple-trauma patients. Crit. Care Med., 2003, 31(8), 2090–2095.

  • 24

    Benus, R. F., Harmsen, H. J., Welling, G. W., et al.: Impact of digestive and oropharyngeal decontamination on the intestinal microbiota in ICU patients. Intensive Care Med., 2010, 36(8), 1394–1402.

  • 25

    Guet-Revillet, H., Le Monnier, A., Breton, N., et al.: Environmental contamination with extended-spectrum β-lactamases: is there any difference between Escherichia coli and Klebsiella spp? Am. J. Infect. Control., 2012, 40(9), 845–848.

  • 26

    Agopian, V. G., Petrowsky, H., Kaldas, F. M., et al.: The evolution of liver transplantation during 3 decades: analysis of 5347 consecutive liver transplants at a single center. Ann. Surg., 2013, 258(3), 409–421.

  • 27

    Nemes, B., Sárváry, E., Sótonyi, P., et al.: Factors in association with sepsis after liver transplantation: the Hungarian experience. Transplant. Proc., 2005, 37(5), 2227–2228.

  • 28

    Micheloud, D., Salcedo, M., Bañares, R., et al.: High rate of infection and immune disorders in patients with hepatitis C virus after liver transplantation. Transpl. Infect. Dis., 2009, 11(4), 367–372.

  • 29

    van Hoek, B., de Rooij, B. J., Verspaget, H. W.: Risk factors for infection after liver transplantation. Best Pract. Res. Clin. Gastroenterol., 2012, 26(1), 61–72.

  • 30

    Feltracco, P., Carollo, C., Barbieri, S., et al.: Early respiratory complications after liver transplantation. World J. Gastroenterol., 2013, 19(48), 9271–9281.

  • 31

    Huang, C. T., Lin, H. C., Chang, S. C., et al.: Pre-operative risk factors predict post-operative respiratory failure after liver transplantation. PLoS ONE, 2011, 6(8), e22689.

  • 32

    Pirat, A., Ozgur, S., Torgay, A., et al.: Risk factors for postoperative respiratory complications in adult liver transplant recipients. Transplant. Proc., 2004, 36(1), 218–220.

  • 33

    Weiss, E., Dahmani, S., Bert, F., et al.: Early-onset pneumonia after liver transplantation: microbiological findings and therapeutic consequences. Liver Transpl., 2010, 16(10), 1178–1185.

  • 34

    Borzio, M., Salerno, F., Piantoni, L., et al.: Bacterial infection in patients with advanced cirrhosis: a multicentre prospective study. Dig. Liver Dis., 2001, 33(1), 41–48.

  • 35

    Kawecki, D., Chmura, A., Pacholczyk, M., et al.: Surgical site infections in liver recipients in the early posttransplantation period: etiological agents and susceptibility profiles. Transplant. Proc., 2007, 39(9), 2800–2806.

  • 36

    Ahmed, E. B., Alegre, M. L., Chong, A. S.: Role of bacterial infections in allograft rejection. Expert Rev. Clin. Immunol., 2008, 4(2), 281–293.

  • 37

    Putnam, C. W., Beart, R. W. Jr., Bell, R. H. Jr., et al.: Hepatic transplantation, 1975. Postgrad. Med. J., 1976, 52(Suppl. 5), 104–108.

  • 38

    Nemes, B., Gámán, G., Doros, A.: Biliary complications after liver transplantation. Expert Rev. Gastroenterol. Hepatol., 2015, 9(4), 447–466.

  • 39

    Op den Dries, S., Sutton, M. E., Lisman, T., et al.: Protection of bile ducts in liver transplantation: looking beyond ischemia. Transplantation, 2011, 92(4), 373–379.

  • 40

    Kawecki, D., Chmura, A., Pacholczyk, M., et al.: Bacteria isolated from bile samples of liver recipients in the early period after transplantation: epidemiology and susceptibility of the bacterial strains. Transplant. Proc., 2007, 39(9), 2807–2811.

  • 41

    Gotthardt, D. N., Weiss, K. H., Rupp, C., et al.: Bacteriobilia and fungibilia are associated with outcome in patients with endoscopic treatment of biliary complications after liver transplantation. Endoscopy, 2013, 45(11), 890–896.

  • 42

    Fiore, A. E., Butler, J. C., Emori, T. G., et al.: A survey of methods used to detect nosocomial legionellosis among participants in the National Nosocomial Infections Surveillance System. Infect. Control. Hosp. Epidemiol., 1999, 20(6), 412–416.

  • 43

    Kirby, R. M., McMaster, P., Clements, D., et al.: Orthotopic liver transplantation: postoperative complications and their management. Br. J. Surg., 1987, 74(1), 3–11.

  • 44

    Kawecki, D., Pacholczyk, M., Łagiewska, B., et al.: Urinary tract infections in the early posttransplant period after liver transplantation: etiologic agents and their susceptibility. Transplant. Proc., 2011, 43(8), 3052–3054.

  • 45

    Rice, J. C., Safdar, N., and AST Infectious Diseases Community of Practice: Urinary tract infections in solid organ transplant recipients. Am. J. Transplant., 2009, 9(Suppl. 4), S267–S272.

  • 46

    Sun, H. Y., Cacciarelli, T. V., Singh, N.: Micafungin versus amphotericin B lipid complex for the prevention of invasive fungal infections in high-risk liver transplant recipients. Transplantation, 2013, 96(6), 573–578.

  • 47

    Winn, W. C., Allen, S. D., Janda, W. M., et al.: Koneman’s color atlas and textbook of diagnostic microbiology. 6th ed. Lippincott Williams and Wilkins, Philadelphia, 2006.

  • 48

    Palazzo, I. C., Araujo, M. L., Darini, A. L.: First report of vancomycin-resistant Staphylococci isolated from healthy carriers in Brazil. J. Clin. Microbiol., 2005, 43(1), 179–185.

  • 49

    Hetem, D. J., de Ruiter, S. C., Buiting, A. G., et al.: Preventing Staphylococcus aureus bacteremia and sepsis in patients with Staphylococcus aureus colonization of intravascular catheters: a retrospective multicenter study and meta-analysis. Medicine (Baltimore), 2011, 90(4), 284–288.

  • 50

    Golia, S., Srilatha, K. T., Vasudha, C. L.: Microbial profile of early and late onset ventilator associated pneumonia in the intensive care unit of a tertiary care hospital in Bangalore, India. J. Clin. Diagn. Res., 2013, 7(11), 2462–2466.

  • 51

    Siu, L. K., Yeh, K. M., Lin, J. C., et al.: Klebsiella pneumoniae liver abscess: a new invasive syndrome. Lancet Infect. Dis., 2012, 12(11), 881–887.

  • 52

    Kang, C. I., Kim, S. H., Bang, J. W., et al.: Community-acquired versus nosocomial Klebsiella pneumoniae bacteremia: clinical features, treatment outcomes, and clinical implication of antimicrobial resistance. J. Korean Med. Sci., 2006, 21(5), 816–822.

  • 53

    Khan, A. S., Dancer, S. J., Humphreys, H.: Priorities in the prevention and control of multidrug-resistant Enterobacteriaceae in hospitals. J. Hosp. Infect., 2012, 82(2), 85–93.

  • 54

    Herzog, T., Chromik, A. M., Uhl, W.: Treatment of complicated intra-abdominal infections in the era of multi-drug resistant bacteria. Eur. J. Med. Res., 2010, 15(12), 525–532.

  • 55

    Terry Alli, O. A., Ogbolu, D. O., Mustapha, J. O., et al.: The non-association of Panton-Valentine leukocidin and mecA genes in the genome of Staphylococcus aureus from hospitals in South Western Nigeria. Indian J. Med. Microbiol., 2012, 30(2), 159–164.

  • 56

    Hanberger, H., Giske, C. G., Giamarellou, H.: When and how to cover for resistant gram-negative bacilli in severe sepsis and septic shock. Curr. Infect. Dis. Rep., 2011, 13(5), 416–425.

  • 57

    Moellering, R. C. Jr.: Advances in antibacterial therapy. Transplant. Proc., 2011, 43(6), 2441–2442.

  • 58

    Lam, O. L., Bandara, H. M., Samaranayake, L. P., et al.: Oral health promotion interventions on oral yeast in hospitalised and medically compromised patients: a systematic review. Mycoses, 2012, 55(2), 123–142.

  • 59

    Zhong, L., Men, T. Y., Li, H., et al.: Multidrug-resistant gram-negative bacterial infections after liver transplantation – spectrum and risk factors. J. Infect., 2012, 64(3), 299–310.

  • 60

    Nemeth, J., Ledergerber, B., Preiswerk, B., et al.: Multidrug-resistant bacteria in travellers hospitalized abroad: prevalence, characteristics, and influence on clinical outcome. J. Hosp. Infect., 2012, 82(4), 254–259.

  • 61

    Snyder, G. M., D’Agata, E. M.: Diagnostic accuracy of surveillance cultures to detect gastrointestinal colonization with multidrug-resistant gram-negative bacteria. Am. J. Infect. Control, 2012, 40(5), 474–476.

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