Influencing factors of multi-drug resistant Acinetobacter baumannii infection in patients after liver transplantation

doi:10.3877/cma.j.issn.2095-3232.2016.03.008

Abstract

Abstract:

Objective

To explore the multi-drug resistance condition and independent risk factors of Acinetobacter baumannii infection in patients after liver transplantation.

Methods

Clinical data of 257 patients who underwent liver transplantation in Shanghai General Hospital between January 2010 and June 2015 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Twenty-five patients were infected with multi-drug resistant Acinetobacter baumannii. Among the patients, 17 were males and 8 were females, 10 were younger than 50 years old and 15 were older or equal to 50 years old. Drug sensitive test was detected using concentration gradient method, metallo-beta-lactamase was detected using composite paper, and bacterial genotype was detected using repetitive sequence polymerase chain reaction (PCR) and gel electrophoresis. Drug resistance, drug-resistant spectrum, genotype distribution, infection time and influence factors of infection for multi-drug resistant Acinetobacter baumannii were observed and analyzed. Single-factor analysis of multi-drug resistant Acinetobacter baumannii was conducted using Chi-square test and multiple-factor analysis was conducted using logistic regression analysis.

Results

The incidence of multi-drug resistant Acinetobacter baumannii infection was 9.7%(25/257). Acinetobacter baumannii strains were highly resistant to aminoglycosides, quinolones, penicillins, cephalosporins and carbapenems, with the drug resistance of 100%. In addition, 96%(24/25) of the strains were metallo-beta-lactamase positive. Three genotypes were observed in the 25 strains of Acinetobacter baumannii: type B (n=18), type A (n=5) and type C (n=2). Positive postoperative fungal culture (OR=5.470, 95%CI: 1.402-21.333, P<0.05) and re-intubation (OR=11.538, 95%CI: 2.228-59.742, P<0.05) were the independent risk factors for multi-drug resistant Acinetobacter baumannii infection.

Conclusions

The incidence of multidrug-resistant Acinetobacter baumannii infection in patients after liver transplantation is high. Multidrug-resistant Acinetobacter baumannii is highly resistant to multiple antibiotics, and type B is the main genetype. Positive postoperative fungal culture and re-intubation are the independent risk factors for multi-drug resistant Acinetobacter baumannii infection.

Key words: Liver transplantation, Multidrug resistance-associated proteins, Acinetobacter baumannii, Infection

Yanping Pu, Yan Gu, Fu Yang, Chunguang Wang, Wen Peng, Fang Fang, Lin Zhong. Influencing factors of multi-drug resistant Acinetobacter baumannii infection in patients after liver transplantation[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2016, 05(03): 158-162.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3232.2016.03.008

https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/Y2016/V05/I03/158

Figures/Tables 2

References 20

[1]	Peleg AY, Seifert H, Paterson DL. Acinetobacter baumannii: emergence of a successful pathogen[J]. Clin Microbiol Rev, 2008, 21(3): 538-582.
[2]	Zarrilli R, Casillo R, Di Popolo A, et al. Molecular epidemiology of a clonal outbreak of multidrug-resistant Acinetobacter baumannii in a university hospital in Italy[J]. Clin Microbiol Infect, 2007, 13(5): 481-489.
[3]	de Oliveira JM, Lisboa Lde B. Hospital-acquired infections due to gram-negative bacteria[J]. N Engl J Med, 2010, 363(15): 1482-1483.
[4]	Raka L, Kalenó S, Bosnjak Z, et al. Molecular epidemiology of Acinetobacter baumannii in central intensive care unit in Kosova teaching hospital[J]. Braz J Infect Dis, 2009, 13(6): 408-413.
[5]	Rayes N, Seehofer D, Theruvath T, et al. Supply of pre- and probiotics reduces bacterial infection rates after liver transplantation--a randomized, double-blind trial[J]. Am J Transplant, 2005, 5(1): 125-130.
[6]	Reddy P, Zembower TR, Ison MG, et al. Carbapenem-resistant Acinetobacter baumannii infections after organ transplantation[J]. Transpl Infect Dis, 2010, 12(1): 87-93.
[7]	Ecker JA, Massire C, Hall TA, et al. Identification of Acinetobacter species and genotyping of Acinetobacter baumannii by multilocus PCR and mass spectrometry[J]. J Clin Microbiol, 2006, 44(8): 2921-2932.
[8]	Durante-Mangoni E, Zarrilli R. Global spread of drug-resistant Acinetobacter baumannii: molecular epidemiology and management of antimicrobial resistance[J]. Future Microbiol, 2011, 6(4): 407-422.
[9]	Viehman JA, Nguyen MH, Doi Y. Treatment options for carbapenem-resistant and extensively drug-resistant Acinetobacter baumannii infections[J]. Drugs, 2014, 74(12): 1315-1333.
[10]	Freire MP, Soares Oshiro IC, Bonazzi PR, et al. Surgical site infections in liver transplant recipients in the model for end-stage liver disease era: an analysis of the epidemiology, risk factors, and outcomes[J]. Liver Transpl, 2013, 19(9): 1011-1019.
[11]	Freire MP, Van Der Heijden IM, do Prado GV, et al. Polymyxin use as a risk factor for colonization or infection with polymyxin-resistant Acinetobacter baumannii after liver transplantation[J]. Transpl Infect Dis, 2014, 16(3): 369-378.
[12]	Bodro M, Sabé N, Tubau F, et al. Risk factors and outcomes of bacteremia caused by drug-resistant ESKAPE pathogens in solid-organ transplant recipients[J]. Transplantation, 2013, 96(9): 843-849.
[13]	Ye QF, Zhao J, Wan QQ, et al. Frequency and clinical outcomes of ESKAPE bacteremia in solid organ transplantation and the risk factors for mortality[J]. Transpl Infect Dis, 2014, 16(5): 767-774.
[14]	Shi SH, Kong HS, Xu J, et al. Multidrug resistant gram-negative bacilli as predominant bacteremic pathogens in liver transplant recipients[J]. Transpl Infect Dis, 2009,11(5): 405-412.
[15]	Gales AC, Jones RN, Sader HS. Global assessment of the antimicrobial activity of polymyxin B against 54731 clinical isolates of Gram-negative bacilli: report from the SENTRY antimicrobial surveillance programme (2001-2004)[J]. Clin Microbiol Infect, 2006, 12(4): 315-321.
[16]	Souli M, Kontopidou FV, Koratzanis E, et al. In vitro activity of tigecycline against multiple-drug-resistant, including pan-resistant, gram-negative and gram-positive clinical isolates from Greek hospitals[J]. Antimicrob Agents Chemother, 2006, 50(9): 3166-3169.
[17]	Falagas ME, Mourtzoukou EG, Polemis M, et al. Trends in antimicrobial resistance of Acinetobacter baumannii clinical isolates from hospitalised patients in Greece and treatment implications[J]. Clin Microbiol Infect, 2007, 13(8): 816-819.
[18]	Lima AL, Oliveira PR, Paula AP. Acinetobacter infection[J]. N Engl J Med, 2008, 358(26): 2846.
[19]	Fournier PE, Richet H. The epidemiology and control of Acinetobacter baumannii in health care facilities[J]. Clin Infect Dis, 2006,42(5): 692-699.
[20]	Wareham DW, Bean DC, Khanna P, et al. Bloodstream infection due to Acinetobacter spp: epidemiology, risk factors and impact of multi-drug resistance[J]. Eur J Clin Microbiol Infect Dis, 2008, 27(7): 607-612.

抗生素	MIC₅₀（μg/ml）	MIC₉₀（μg/ml）	耐药率(%)
庆大霉素	>32	>32	100
哌拉西林钠	>256	>256	100
头孢噻肟钠	>128	>128	100
头孢他啶	>64	>64	100
头孢吡肟	>64	>64	100
环丙沙星	>8	>8	100
哌拉西林钠/他唑巴坦钠	>256/4	>256/4	100
亚胺培南	>32	>32	100
美罗培南	>32	>32	100

抗生素	MIC₅₀（μg/ml）	MIC₉₀（μg/ml）	耐药率(%)
庆大霉素	>32	>32	100
哌拉西林钠	>256	>256	100
头孢噻肟钠	>128	>128	100
头孢他啶	>64	>64	100
头孢吡肟	>64	>64	100
环丙沙星	>8	>8	100
哌拉西林钠/他唑巴坦钠	>256/4	>256/4	100
亚胺培南	>32	>32	100
美罗培南	>32	>32	100

?	OR	95%CI	P值
术后真菌培养阳性	5.470	1.402～21.333	0.014
再次气管插管	11.538	2.228～59.742	0.004

?	OR	95%CI	P值
术后真菌培养阳性	5.470	1.402～21.333	0.014
再次气管插管	11.538	2.228～59.742	0.004

Please choose a citation manager

Content to export