Bacterial translocation in clinical intestinal transplantation
Bacterial translocation in clinical intestinal transplantation
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DOI：
10.1097/00007890-200105270-00010
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发表时间：
2001-05-27
期刊：
影响因子：
6.2
通讯作者：
Reyes, J
中科院分区：
文献类型：
--
作者：
Cicalese, L;Sileri, P;Reyes, J
背景。细菌易位（BT）被认为是小肠移植（SBTx）后感染发生率高的原因。细菌过度生长、由于保存损伤或急性排斥反应 (AR) 而导致的粘膜屏障功能改变以及强效免疫抑制均与 BT 相关。本研究的目的是评估和量化 BT 与这些事件的相关性。方法。对 50 名接受他克莫司和泼尼松免疫抑制的儿童 SBTx 接受者进行了分析。当临床怀疑感染或作为随访的一部分时，培养血液、粪便、肝活检和腹膜液（总共约 4000 个样本），当血液或肝活检和粪便中同时发现微生物时，考虑 BT 发作。结果。 BT（平均 2.0 次/患者）在 44% 的患者中很明显，最常由肠球菌、葡萄球菌、肠杆菌和克雷伯氏菌引起。同种异体结肠移植物的存在与较高的 BT 发生率相关（75% vs. 33.3%），此外，移植手术（结肠 vs. 无结肠）影响 BT 发生率：SBTx=40% vs. 25%，联合肝脏和SBTx=100% vs. 30%，多脏器移植=25% vs. 50%。 AR 与 39% 的 BT 发作有关。 9.6% 的病例继 AR 后进行 BT，5.2% 的病例血培养呈阳性，但粪便未确认细菌。延长冷缺血时间 (CIT) 显着影响 BT 率（CIT >9 小时 76% 与 CIT
Background. Bacterial translocation (BT) has been suggested to be responsible for the high incidence of infections occurring after small bowel transplantation (SBTx). Bacterial overgrowth, alteration of the mucosal barrier function as a consequence of preservation injury or acute rejection (AR), and potent immunosuppression are all associated with BT, The aim of this study was to evaluate and quantify the correlation of BT with these events.Methods. Fifty pediatric SBTx recipients on tacrolimus and prednisone immunosuppression were analyzed. Blood, stool, and liver biopsies and peritoneal fluid were cultured (circa 4000 total specimens) when infection was clinically suspected or as part of followup, BT episodes were considered when microorganisms were found simultaneously in blood or liver biopsy and stool.Results. BT (average of 2.0 episodes/patient) was evident in 44% of patients and was most frequently caused by Enterococcus, Staphylococcus, Enterobacter, and Klebsiella, The presence of a colon allograft was associated with a higher rate of BT (75% vs. 33.3%), Furthermore, the transplantation procedure (colon vs. no colon) affected the rate of BT: SBTx=40% vs. 25%, combined Liver and SBTx=100% vs. 30%, multivisceral transplantation=25% vs. 50%. AR was associated with 39% of BT episodes. BT followed AR in 9.6% of the cases, In 5.2% of the cases, positive blood cultures without stool confirmation of the bacteria were seen. Prolonged cold ischemia time (CIT) affected BT rate significantly (CIT >9 hr 76% vs. CIT