Медицинская литература. Новинки

 

 

 

 

 

 

Факторы риска и прогнозирование бактериальных осложнений при трансплантации печени

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Цель исследования. Системный анализ клинических и эпидемиологических факторов риска бактериальных осложнений после трансплантации печени, оценка эффективности алгоритма их профилактики. Материал и методы. Анализировали результаты лечения 1000 реципиентов, которым с апреля 2008 г. по апрель 2023 г. выполнена трансплантация печени. Оценивали связь инфекций, ассоциированных с оказанием медицинской помощи, с основными факторами риска, в том числе контаминацией различных локусов донора и консервирующего раствора. Результаты. Частота инфекций, связанных с оказанием медицинской помощи, составила 22,2%. Совокупная частота контаминации донорского органа и реципиента составила 9,85%. Перенос инфекции произошел в 29% наблюдений. Сепсис развился у 8% всех реципиентов с инфекцией, связанной с оказанием медицинской помощи. Летальность при сепсисе составила 70%. Общая госпитальная летальность после трансплантации печени составила 9,3%. Экстренные показания к трансплантации были в 10,7% наблюдений. При однофакторном регрессионном анализе степень вклада в риск инфекции, связанной с оказанием медицинской помощи, была наибольшей для балла MELD, контаминации консервирующего раствора полирезистентной флорой, тяжелой ранней дисфункции трансплантата, кровопотери и продолжительности тепловой ишемии. Заключение. Контаминация консервирующего раствора увеличивает риск развития бактериальных осложнений после трансплантации печени. Профиль резистентности флоры влияет на срок развития этих осложнений, структуру и исход. Своевременная диагностика и меры инфекционного контроля имеют основополагающее значение для предотвращения инфекционных осложнений у реципиентов.

Ключевые слова:
печень, трансплантация, бактериальные осложнения, контаминация, полирезистентная флора, антибиотикотерапия, антибиотикопрофилактика

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Risk factors and prediction of bacterial complications in liver transplantation

Aim. To conduct a systems analysis of clinical and epidemiological risk factors of bacterial complications associated with liver transplantation, to evaluate the effectiveness of their prevention algorithm. Materials and methods. The authors analyzed the treatment outcomes of 1000 recipients who underwent liver transplantation from April 2008 to April 2023. The study involved analysis of correlation between infections associated with health care and main risk factors, including contamination of different loci and preservation solution. Results. The incidence of healthcare-associated infections accounted for 22.2%. The cumulative incidence of donor organ and recipient contamination was 9.85%. Transmission of infection occurred in 29% of cases. Sepsis developed in 8% of all recipients with healthcare-associated infection. The mortality rate was 70% in cases of sepsis. After liver transplantation, in-hospital mortality was 9.3%. Urgent transplantation was required in 10.7% of observations. Univariate regression analysis shows the highest risk contribution to healthcare-associated infection for the MELD score, contamination of preservation solution with multidrug-resistant flora, severe early graft dysfunction, blood loss, and warm ischemia time. Conclusion. Contamination of preservation solution increases the risk of bacterial complications associated with liver transplantation. The resistance profile affects the development time, structure and outcome of these complications. Timely diagnosis and infection control measures are fundamental to preventing the infectious complications.

Keywords:
liver, transplantation, bacterial complications, contamination, multidrug-resistant flora, antibiotic therapy, antibiotic prophylaxis