Risk factors of early bacterial infection and analysis of bacterial composition, distribution and drug susceptibility after liver transplantation

Abstract Objective This study provides a theoretical basis for the clinical diagnosis and treatment of bacterial infection after liver transplantation through analyzing the pathogenic distribution, drug sensitivity and risk factors of bacterial infection after liver transplantation. Method We collected clinical data from 207 recipients following liver transplantation in the Third Xiangya Hospital of Central South University from January 2019 to December 2021 and analyzed the composition and distribution of bacterial pathogens, drug resistance and risk factors of infection. Results A total of 90 bacterial infections occurred in 55 recipients within two months after liver transplantation, and the incidence of bacterial infection was 26.6% (55/207). The gram-negative bacteria (46/90, 51.1%) were more prevalent than the gram-positive bacteria (44/90, 48.9%). Most common site of infection was abdominal/biliary tract (26/90, 28.9%), lung (22/90, 22.4%) and urinary tract (22/90, 22.4%). Fourteen cases (6.8%) died after liver transplantation. Klebsiella pneumoniae (17/90, 18.9%) was the most frequent gram-negative bacteria causing infection in liver transplant recipients and Most of gram-negative bacteria were sensitive to amikacin, minocycline, tigecycline and polymyxin B. The most common gram-positive bacteria was Enterococcus faecium (30/90, 33.3%) and the most of the gram-positive bacteria were sensitive to vancomycin, teicoplanin, daptomycin, tigecycline and linezolid. Univariate analysis revealed that bacterial infection was associated with female, age (≥ 50 years old), preoperative albumin (≤ 30 g/L), operation duration (≥ 400 min), intraoperative blood loss (≥ 3000 ml) and postoperative ventilator support. Binary Logistic regression analysis showed that female (OR = 3.149, 95% CI: 1.418–6.993, P = 0.005), operation duration (≥ 400 min) (OR = 2.393, 95% CI: 1.202–4.765, P = 0.013) and intraoperative blood loss (≥ 3000 ml) (OR = 2.052, 95% CI: 1.007–4.183, P = 0.048) were independent risk factors for bacterial infection after liver transplantation. Conclusion The incidence of early bacterial infection after liver transplantation was high, and the infection sites were mainly abdominal/biliary tract, respiratory tract and urinary tract. The most common pathogenic bacterium was gram-negative bacterium. Female, operation duration (≥ 400 min) and intraoperative blood loss (≥ 3000 ml) were independent risk factors for bacterial infection after liver transplantation. Improving surgical technique, shortening operation time and reducing intraoperative blood loss might play a positive role in reducing bacterial infection after liver transplantation.