Epidemiology of Bloodstream Infections in a Multicenter Retrospective Cohort of Liver Transplant Recipients.
Epidemiology of Bloodstream Infections in a Multicenter Retrospective Cohort of Liver Transplant Recipients.
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多中心回顾性肝移植受者的血流感染的流行病学。
DOI：
10.1097/txd.0000000000000573
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发表时间：
2016-03
影响因子：
2.3
通讯作者：
Olsen MA
中科院分区：
文献类型：
--
作者：
Santos CA;Hotchkiss RS;Chapman WC;Olsen MA
补充的数字内容可在文本中找到。尽管一些研究调查了肝移植后血流感染的流行病学，但它们是基于单一中心的，并没有确定在其他医院治疗的血流感染。我们回顾性检查了来自24个移植中心的7912名成人肝移植受者队列，使用来自3个国家住院患者数据库的2004 - 2012年《国际疾病分类》第九版《临床修改》账单数据，并确定了血流感染、住院患者死亡和1年累计住院费用。采用多水平Cox回归分析确定与血液感染和死亡相关的因素。29% （n = 2326）的肝移植受者存在血流感染，移植中心的血流感染范围为19%至40%。在移植后超过100天的血液感染中，只有63%是在原移植中心发现的。血流感染与移植后剖腹手术（校正危险比[aHR]， 1.52）、既往肝移植（aHR, 1.42）、年龄增加（aHR， 1.07/ 10年）和一些合并症相关。死亡与伴或不伴感染性休克的血流感染（aHR分别为10.96和3.71）、移植失败或排斥反应（aHR, 1.41）、移植后剖腹手术（aHR, 1.40）、既往实体器官移植（aHR, 1.48）、年龄增长（aHR， 1.15/ 10年）和丙型肝炎肝硬化（aHR, 1.20）相关。血液感染和死亡的风险因移植中心而异。移植后1年内发生血流感染的患者1年累计住院费用中位数高于无血流感染的患者（229 806美元vs 111 313美元；P < 0.001）。血流感染是肝移植术后常见且代价高昂的并发症，与死亡风险显著增加相关。不同移植中心发生血流感染的发生率和风险可能不同。
Supplemental digital content is available in the text. Although some studies have examined the epidemiology of bloodstream infections after liver transplantation, they were based in single centers and did not identify bloodstream infections treated in other hospitals. We retrospectively examined a cohort of 7912 adult liver transplant recipients from 24 transplant centers using 2004 to 2012 International Classification of Diseases, Ninth Revision, Clinical Modification billing data from 3 State Inpatient Databases, and identified bloodstream infections, inpatient death, and cumulative 1-year hospital costs. Multilevel Cox regression analyses were used to determine factors associated with bloodstream infections and death. Bloodstream infections were identified in 29% (n = 2326) of liver transplant recipients, with a range of 19% to 40% across transplant centers. Only 63% of bloodstream infections occurring more than 100 days posttransplant were identified at the original transplant center. Bloodstream infections were associated with posttransplant laparotomy (adjusted hazard ratio [aHR], 1.52), prior liver transplant (aHR, 1.42), increasing age (aHR, 1.07/decade), and some comorbidities. Death was associated with bloodstream infections with and without septic shock (aHR, 10.96 and 3.71, respectively), transplant failure or rejection (aHR, 1.41), posttransplant laparotomy (aHR, 1.40), prior solid-organ transplant (aHR, 1.48), increasing age (aHR, 1.15/decade), and hepatitis C cirrhosis (aHR, 1.20). The risk of bloodstream infections and death varied across transplant centers. Median 1-year cumulative hospital costs were higher for patients who developed bloodstream infections within 1 year of transplant compared with patients who were bloodstream infection-free (US $229 806 vs US $111 313; P < 0.001). Bloodstream infections are common and costly complications after liver transplantation that are associated with a markedly increased risk of death. The incidence and risk of developing bloodstream infections may vary across transplant centers.