Epidemiology, antimicrobial resistance and risk factors of infection among liver transplant patients in East China: a retrospective study 2010 to 2023

Abstract

Abstract Background Liver transplantation (LT) recipients exhibit heightened susceptibility to infection and sepsis, which have emerged as the most prevalent and life-threatening complications significantly impacting prognosis. The etiological spectrum of organisms following LT has undergone substantial changes over recent decades. Methods This retrospective monocentric study included a consecutive cohort of 776 LT patients from 2010 to 2023, in contrast to our previous study conducted from 2007 to 2010. Infection was diagnosed as per the established definition, and sepsis was diagnosed based on the sepsis-3 criteria. Infection was diagnosed as per the established definition, and sepsis was diagnosed based on the sepsis-3 criteria. Samples were collected from infection sites, cultured, and isolated for further analysis. Results A total of 207 pathogens were isolated from 180 infection sites of 156 (20.1%) patients, comprising of 82 (39.6%) gram-positive bacteria, 90 (43.5%) gram-negative bacteria, and 35 (16.9%) fungi. Among the gram-positive bacteria, we identified Methicillin-resistant Staphylococcus aureus (MRSA) in 18 cases, Methicillin-resistant coagulase-negative staphylococci (MRCNS) in 25 cases, and Vancomycin-resistant Enterococcus faecium (VRE) in 1 case. In terms of gram-negative bacteria, Carbapenem-resistant Enterobacteriaceae (CRE) was found in 8 cases (7 Klebsiella pneumoniae and 1 Escherichia coli), Extended-spectrum beta-lactamases (ESBLs)-producing bacteria were detected in 7 cases (5 Escherichia coli and 2 Enterobacter cloacae), Carbapenem-resistant Acinetobacter baumannii (CRAB) was found in 14 cases, and 2 cases had Carbapenem-resistant Pseudomonas aeruginosa (CRPA). Advanced age, prolonged mechanical ventilation, and extended ICU stay were significantly associated with increased susceptibility to post-LT infections. Infected patients with bilirubin levels exceeding 90 μmol/L (OR 3.46, 95% CI 1.46-8.24; P = 0.005) as well as drug-resistance bacterial infections (OR 2.35, 95% CI 1.07-5.15; P = 0.033) were more likely to develop sepsis. Conclusions More than 45% of bacterial infections were caused by drug-resistant pathogens, with over 30% of gram-negative bacteria exhibiting carbapenem resistance. Implementation of strategies aimed at reducing the duration of mechanical ventilation and ICU stay may effectively decrease the incidence of post-liver transplantation infection. Furthermore, pre-transplant interventions targeting reduction in jaundice could potentially mitigate the risk of post-transplant sepsis.