Incidence and risk factors of postoperative multidrug-resistant bacterial infections in liver transplant patients: A meta-analysis

doi:10.3969/j.issn.1004-583X.2024.11.001

Abstract

Abstract:

Objective To identify the incidence and risk factors of postoperative multidrug-resistant bacterial infections in liver transplant patients.Methods A systematic search of the literatures was conducted in the Cochrane Library, CINAHL, Embase, Web of science, Pubmed, SinoMed, China National Knowledge Infrastructure (CNKI), Wanfang Data, and CQVIP up to July 2023. Stata16.0 and RevMan5.4 software were used to perform meta-analysis.Results A total of 13 articles representing 5,877 patients were included, and 40 risk factors were extracted. The results of the meta-analysis showed that the combined incidence of postoperative multidrug-resistant bacterial infections in liver transplant patients was 18%, with an incidence ranging from 3% to 48%. The main risk factors included pre-transplant ICU admission (OR=3.71, 95%CI: 2.52-5.46), colonization rate of carbapenem-resistant Acinetobacter baumannii (CRAB) before liver transplant (OR=10.73, 95%CI: 3.79-30.37), the model for End-Stage Liver Disease (MELD) score (OR=5.85, 95%CI: 0.68-11.2), length of post-transplant ICU stay (OR=4.34,95%CI: 2.84-5.84), post-transplant dialysis (OR=2.61, 95%CI: 1.60-4.25), reoperation (OR=4.22, 95%CI: 2.07-8.63), prolonged prothrombin time (OR=1.01, 95%CI: 0.30-1.54), and biliary complications (OR=3.52, 95%CI: 1.98-6.23).Conclusion The incidence of postoperative multidrug-resistant bacterial infections in liver transplantation patients is high. There are many risk factors to be concerned to reduce the incidence of postoperative multidrug-resistant bacterial infections in liver transplantation patients, thus improving the survival.

Key words: liver transplantation, multi-drug resistant bacteria infection, risk factors, incidence rate, meta-analysis

CLC Number:

R657.3

He Tian, Han Linqiu, Shi Zuxin, Shen Mingyan. Incidence and risk factors of postoperative multidrug-resistant bacterial infections in liver transplant patients: A meta-analysis[J]. Clinical Focus, 2024, 39(11): 965-973.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2024.11.001

https://huicui.hebmu.edu.cn/EN/Y2024/V39/I11/965

Figures/Tables 18

References 32

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序号	检索策略
#1	multiple resistant bacteria[Title/Abstract] OR MDRO[Title/Abstract] OR multidrug resistance[MeSH Terms] OR multidrug resistance[Title/Abstract] OR multidrug resistant bacteria[Title/Abstract]
#2	liver transplantation[MeSH Terms] OR liver transplantations[MeSH Terms] OR liver transplant[Title/Abstract] OR liver grafting[MeSH Terms] OR liver graftings[MeSH Terms] OR liver graft[Title/Abstract] OR liver receiver[Title/Abstract] OR hepatic transplantation[MeSH Terms] OR hepatic transplantations[MeSH Terms] OR hepatic transplantation?[Title/Abstract] OR hepatic receiver[Title/Abstract] OR hepatic grafting [Title/Abstract]
#3	relevant factors[Title/Abstract] OR risk factors[MeSH Terms] OR risk factors[Title/Abstract] OR risk factor[MeSH Terms] OR risk factor[Title/Abstract] OR associate factors[Title/Abstract] OR dangerous factors[Title/Abstract] OR predictive factors[Title/Abstract]
#4	#1 AND #2 AND #3

序号	检索策略
#1	multiple resistant bacteria[Title/Abstract] OR MDRO[Title/Abstract] OR multidrug resistance[MeSH Terms] OR multidrug resistance[Title/Abstract] OR multidrug resistant bacteria[Title/Abstract]
#2	liver transplantation[MeSH Terms] OR liver transplantations[MeSH Terms] OR liver transplant[Title/Abstract] OR liver grafting[MeSH Terms] OR liver graftings[MeSH Terms] OR liver graft[Title/Abstract] OR liver receiver[Title/Abstract] OR hepatic transplantation[MeSH Terms] OR hepatic transplantations[MeSH Terms] OR hepatic transplantation?[Title/Abstract] OR hepatic receiver[Title/Abstract] OR hepatic grafting [Title/Abstract]
#3	relevant factors[Title/Abstract] OR risk factors[MeSH Terms] OR risk factors[Title/Abstract] OR risk factor[MeSH Terms] OR risk factor[Title/Abstract] OR associate factors[Title/Abstract] OR dangerous factors[Title/Abstract] OR predictive factors[Title/Abstract]
#4	#1 AND #2 AND #3

作者	国家	研究类型	耐药菌类型	样本量(例)		感染率	危险因素	NOS评分 (分)
作者	国家	研究类型	耐药菌类型	总样本	感染/未感染	感染率	危险因素	NOS评分 (分)
Kim等^[4]	韩国	病例对照	CRAB	393	14/379	4%	1、2、3、39	7
Min等^[5]	韩国	病例对照	CRAB	174	29/145	17%	4、5、6、7、8	8
Wu等^[6]	中国	病例对照	CRO	136	15/121	11%	9、10	7
Mazza等^[7]	意大利	病例对照	CRKP	310	8/302	3%	1、10、11、12、13、14、20、29	6
杨富等^[8]	中国	病例对照	MDRO	366	88/278	24%	15、16、17、20、24	8
方翊天等^[9]	中国	病例对照	MDRO	77	26/51	33%	10、17、18、19	7
Chen等^[10]	中国	病例对照	CRE	387	26/361	67%	18、20、21	7
Freire等^[11]	巴西	队列研究	MDRO	229	109/120	47%	1、2、6、7、21、22、23、29	7
Liu等^[12]	中国	队列研究	CRKP	294	62/232	21%	3、25、26、27	8
刘梦元等^[13]	中国	队列研究	MDRO	114	28/86	25%	3、6、7、10、17、16、28	7
Freire等^[14]	巴西	队列研究	CRE	1660	116/1 544	7%	9、24、29、30、31、32、33	7
Giannella等^[15]	巴西	队列研究	CRE	840	250/590	30%	21、26、33、34、35、36	7
Anesi等^[16]	美国	队列研究	CRE	897	70/827	8%	9、21、37、38	7

作者	国家	研究类型	耐药菌类型	样本量(例)		感染率	危险因素	NOS评分 (分)
作者	国家	研究类型	耐药菌类型	总样本	感染/未感染	感染率	危险因素	NOS评分 (分)
Kim等^[4]	韩国	病例对照	CRAB	393	14/379	4%	1、2、3、39	7
Min等^[5]	韩国	病例对照	CRAB	174	29/145	17%	4、5、6、7、8	8
Wu等^[6]	中国	病例对照	CRO	136	15/121	11%	9、10	7
Mazza等^[7]	意大利	病例对照	CRKP	310	8/302	3%	1、10、11、12、13、14、20、29	6
杨富等^[8]	中国	病例对照	MDRO	366	88/278	24%	15、16、17、20、24	8
方翊天等^[9]	中国	病例对照	MDRO	77	26/51	33%	10、17、18、19	7
Chen等^[10]	中国	病例对照	CRE	387	26/361	67%	18、20、21	7
Freire等^[11]	巴西	队列研究	MDRO	229	109/120	47%	1、2、6、7、21、22、23、29	7
Liu等^[12]	中国	队列研究	CRKP	294	62/232	21%	3、25、26、27	8
刘梦元等^[13]	中国	队列研究	MDRO	114	28/86	25%	3、6、7、10、17、16、28	7
Freire等^[14]	巴西	队列研究	CRE	1660	116/1 544	7%	9、24、29、30、31、32、33	7
Giannella等^[15]	巴西	队列研究	CRE	840	250/590	30%	21、26、33、34、35、36	7
Anesi等^[16]	美国	队列研究	CRE	897	70/827	8%	9、21、37、38	7

亚组	纳入文献数量 (篇)	异质性检验结果		效应模型	效应量	95%CI
亚组	纳入文献数量 (篇)	I²(%)	P值	效应模型	效应量	95%CI
地区
亚洲	8	95.4%	<0.001	随机	0.17	0.10~0.24
非亚洲	5	98.9%	<0.001	随机	0.18	0.10~0.27
耐药菌类型
CRKP	2	98.1%	<0.001	随机	0.12	0.06~0.30
CRAB	2	94.8%	<0.001	随机	0.10	0.03~0.23
MDRO	4	92%	<0.001	随机	0.32	0.20~0.45
CRE	4	98.4%	<0.001	随机	0.13	0.05~0.20