Distribution, Drug Resistance, and Risk Factors of Infection in Liver Transplant Recipients With Liver Failure

Abstract

Background

The aim of this study was to explore strategies for postoperative infection prevention and treatment, and how they might help to improve the prognosis in liver transplant recipients with liver failure.

Methods

We retrospectively investigated 98 recipients with liver failure in the Surgical Intensive Care Unit of The First Affiliated Hospital of Xi'an Jiaotong University from January 2019 to December 2023, and the pathogens distribution, drug resistance, and risk factors of infection after liver transplantation were analyzed.

Results

The incidence of infection was 48.0%, with common infection sites including the respiratory tract, abdominal cavity, biliary tract, and bloodstream. A total of 145 pathogens were isolated, 110 (75.9%) of which were Gram-negative bacteria, 30 (20.7%) were Gram-positive bacteria, and 5 (3.4%) were fungi. The most common pathogenic bacteria were Klebsiella pneumoniae, Acinetobacter baumannii, Enterococcus faecalis, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. Drug sensitivity data showed that Klebsiella pneumoniae showed a high resistance rate (over 70%) to all tested antibiotics except for tigecycline, colistin, and ceftazidime avibactam. Acinetobacter baumannii was highly sensitive to colistin and tigecycline, with a sensitivity of over 50% to minocycline and aminoglycosides, and a resistance rate of over 70% to other tested antibiotics. No Gram-positive strain was resistant to tigecycline, linezolid, vancomycin, and teicoplanin. Risk factor analysis suggested that preoperative infection within 2 months was an independent risk factor for infection after liver transplantation in recipients with liver failure.

Conclusions

The incidence of postoperative infection in liver failure recipients was high, and the respiratory tract and abdomen were the most common sites. The pathogenic bacteria were mainly Gram-negative bacteria, which showed an extensive and high drug resistance. Patients with liver failure who underwent liver transplantation with a preoperative infection within 2 months of the transplantation were more likely to develop an infection after surgery.