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Risk factors for pneumonia caused by multidrug‐resistant Gram‐negative bacilli among liver recipients
Author(s) -
Shi Shao Hua,
Kong Hai Shen,
Jia Chang Ku,
Zhang Wen Jin,
Xu Jian,
Wang Wei Lin,
Shen Yan,
Zhang Min,
Zheng Shu Sen
Publication year - 2010
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2009.01184.x
Subject(s) - medicine , pneumonia , pseudomonas aeruginosa , acinetobacter baumannii , multiple drug resistance , bacilli , incidence (geometry) , mortality rate , bacterial pneumonia , gastroenterology , liver transplantation , acinetobacter , microbiology and biotechnology , transplantation , antibiotics , bacteria , biology , genetics , physics , optics
Shi SH, Kong HS, Jia CK, Zhang WJ, Xu J, Wang WL, Shen Y, Zhang M, Zheng SS. Risk factors for pneumonia caused by multidrug‐resistant Gram‐negative bacilli among liver recipients.
Clin Transplant 2010: 24: 758–765. © 2009 John Wiley & Sons A/S. Abstract: Pneumonia caused by multidrug‐resistant (MDR) Gram‐negative bacilli is associated with a higher mortality rate. The appropriate empiric therapy is based on the understanding of local etiology and MDR pattern. This study was to evaluate the spectrum of Gram‐negative bacilli, MDR rate, risk factors and mortality in 475 liver transplantation (LT) recipients. In the first six months after LT, the incidence of bacterial pneumonia was 21.3% (101/475). The overall infectious incidence during the first post‐transplant month was 80.2%. The most frequent pneumonia isolates were Enterobacteriaceae, Acinetobacter baumannii , Pseudomonas aeruginosa and Staphylococcus aureus . Gram‐negative bacilli accounted for 69.6% of all pneumonia pathogens. Of the main 124 Gram‐negative bacilli isolates, MDR rate was 58.9%. Four risk factors for post‐LT pneumonia caused by MDR Gram‐negative bacilli were LT candidates with grade II–IV encephalopathy (OR 2.275, 95%CI 1.249–4.124, p = 0.006), prolonged duration of endotracheal intubation (OR 8.224, 95%CI 4.276–15.815, p = 0.013), tracheostomy (OR 4.929, 95%CI 1.099–18.308, p = 0.027) and post‐LT episode(s) of reoperations (OR 10.597, 95%CI 3.726–30.134, p < 0.001). MDR Gram‐negative bacterial pneumonia‐related mortality was significantly higher than that because of antibiotic‐susceptible bacilli (45.6% vs. 11.4%, p = 0.010). Our data suggest that pneumonia caused by MDR Gram‐negative bacilli after LT is common, and associated with the severity of underlying disease, prolonged mechanical ventilation and upper abdominal surgery.