Infections by multidrug-resistant bacteria (MDRB) are an increasing healthcare problem worldwide. This study analyzes the incidence, burden, and risk factors associated with MDRB infections after liver transplant(ation) (LT). This retrospective, multicenter cohort study included adult patients who underwent LT between January 2017 and January 2020. Risk factors related to pre-LT disease, surgical procedure, and postoperative stay were analyzed. Multivariate logistic regression analysis was performed to identify independent predictors of MDRB infections within the first 90 days after LT. We included 1,045 LT procedures (960 patients) performed at nine centers across Spain. The mean age of our cohort was 56.8 ± 9.3 years; 75.4% (n = 782) were male. Alcohol-related liver disease was the most prevalent underlying etiology (43.2.%, n = 451). Bacterial infections occurred in 432 patients (41.3%) who presented with a total of 679 episodes of infection (respiratory infections, 19.3%; urinary tract infections, 18.5%; bacteremia, 13.2% and cholangitis 11%, among others). MDRB were isolated in 227 LT cases (21.7%) (348 episodes). (22.1%), (18.4%), and (15.2%) were the most frequently isolated microorganisms. In multivariate analysis, previous intensive care unit admission (0-3 months before LT), previous MDRB infections (0-3 months before LT), and an increasing number of packed red blood cell units transfused during surgery were identified as independent predictors of MDRB infections. Mortality at 30, 90, 180, and 365 days was significantly higher in patients with MDRB isolates. MDRB infections are highly prevalent after LT and have a significant impact on prognosis. is the most frequently isolated multi-resistant microorganism. New pharmacological and surveillance strategies aimed at preventing MDRB infections after LT should be considered for patients with risk factors. Multidrug-resistant bacterial infections have a deep impact on morbidity and mortality after liver transplantation. Strategies aimed at improving prophylaxis, early identification, and empirical treatment are paramount. Our study unveiled the prevalence and main risk factors associated with these infections, and demonstrated that gram-positive bacteria, particularly , are frequent in this clinical scenario. These findings provide valuable insights for the development of prophylactic and empirical antibiotic treatment protocols after liver transplantation.

中文翻译：

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肝移植后多重耐药细菌感染：患病率、影响和危险因素

多重耐药细菌 (MDRB) 感染是全球日益严重的医疗保健问题。本研究分析了肝移植（LT）后与 MDRB 感染相关的发病率、负担和危险因素。这项回顾性、多中心队列研究纳入了 2017 年 1 月至 2020 年 1 月期间接受 LT 的成年患者。分析了与 LT 前疾病、手术过程和术后住院相关的危险因素。进行多变量逻辑回归分析以确定 LT 后前 90 天内 MDRB 感染的独立预测因素。我们纳入了在西班牙 9 个中心进行的 1,045 例 LT 手术（960 名患者）。我们队列的平均年龄为 56.8 ± 9.3 岁； 75.4% (n = 782) 为男性。酒精相关的肝病是最常见的潜在病因（43.2.%，n = 451）。 432 名患者（41.3%）发生细菌感染，共出现 679 次感染（呼吸道感染，19.3%；尿路感染，18.5%；菌血症，13.2%，胆管炎 11% 等）。在 227 例 LT 病例（21.7%）（348 次发作）中分离出 MDRB。 （22.1%）、（18.4%）和（15.2%）是最常分离到的微生物。在多变量分析中，既往入住重症监护病房（LT 前 0-3 个月）、既往 MDRB 感染（LT 前 0-3 个月）以及手术期间输注的浓缩红细胞单位数量增加被确定为 MDRB 的独立预测因子感染。 MDRB 分离株患者在 30、90、180 和 365 天的死亡率显着较高。 MDRB 感染在 LT 后非常普遍，对预后有重大影响。是最常分离到的多重耐药微生物。对于有危险因素的患者，应考虑旨在预防 LT 后 MDRB 感染的新药理学和监测策略。多重耐药细菌感染对肝移植后的发病率和死亡率具有深远的影响。旨在改善预防、早期识别和经验治疗的策略至关重要。我们的研究揭示了与这些感染相关的患病率和主要危险因素，并证明革兰氏阳性菌，特别是革兰氏阳性菌，在这种临床情况下很常见。这些发现为肝移植后预防性和经验性抗生素治疗方案的制定提供了宝贵的见解。