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Evaluation of the guidelines for infection control and prevention, which was made for national university hospitals in Japan

为日本国立大学医院制定的感染控制和预防指南的评估

基本信息

批准号：
17591327
负责人：
IINUMA Yoshitsugu
金额：
$ 2.31万
依托单位：
Kyoto University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
2005
资助国家：
日本
起止时间：
2005 至 2007
项目状态：
已结题

项目摘要

The incidence of infection after liver transplantation (LT) is generally high because of the technical complexity and potentially contaminated environment within the abdominal cavity. Our main aim in this study was to investigate if the infection rate in LT could be reduced when probiotics and immunonutrition were supplemented. And we evaluated the influence of change of prophylactic antimicrobials (ABPC and CTX) to bacteremia after LT, and investigated risk factors for the severe and representative opportunistic post-LT infection by invasive aspergillosis (IA) and cytomegalovirus (CMV). Because of the difficulty of probiotics and immunonutrition intake according to study protocol, enrollment were insufficient for analysis. However, the safety of these drugs for LT recipients could be demonstrated, therefore, we are planning the additional study by the modified protocol. The incidence of bacteremia decreased significantly from 26.3 per 100 LDLT in PRE period (2000-02) to 18.4 in POST period (03-06). Bacteremia caused by both ABPC and CTX- resistant species decreased (from 15.1 to 10.1) more than those by susceptible species (from 11.2 to 8.4), with remarkable reduction of bacteremia caused by MRSA (from 5.0 to 2.5) and enterococci (from 7.7 to 4.5). Risk factors for IA were preoperative intensive care unit stay and preoperative steroid administration. Preoperative steroid administration for fulminant hepatitis (FH) possibly predisposed to the development of IA after LT. Also, multivariate analysis revealed FH as an underlying disease, ABO-incompatible LT, and a serological combination of the donor positive/recipient negative for CMV (D+/R-) were independently associated with the development of CMV infection. The data obtained by this study revealed the evidence for the management of LT recipients to prevent severe bacterial infection, IA, and CMV infection.

由于技术复杂且腹腔内环境可能受到污染，肝移植（LT）后感染的发生率普遍较高。我们本研究的主要目的是调查补充益生菌和免疫营养是否可以降低 LT 感染率。我们评估了预防性抗菌药物（ABPC 和 CTX）的变化对 LT 后菌血症的影响，并调查了侵袭性曲霉病（IA）和巨细胞病毒（CMV）引起的严重和代表性机会性 LT 后感染的危险因素。由于根据研究方案很难摄入益生菌和免疫营养，因此入组人数不足以进行分析。然而，这些药物对 LT 接受者的安全性是可以证明的，因此，我们正在计划通过修改方案进行额外的研究。菌血症发生率从前期（2000-02年）每100个LDLT 26.3个显着下降至后期（03-06年）18.4个。由 ABPC 和 CTX 耐药物种引起的菌血症下降幅度（从 15.1 降至 10.1）多于易感物种（从 11.2 降至 8.4），其中 MRSA（从 5.0 至 2.5）和肠球菌（从 7.7 至 4.5）引起的菌血症显着下降。 IA 的危险因素是术前入住重症监护病房和术前使用类固醇。暴发性肝炎 (FH) 术前使用类固醇可能导致 LT 后发生 IA。此外，多变量分析显示 FH 作为一种基础疾病、ABO 不相容 LT 以及 CMV 供体阳性/受体阴性 (D+/R-) 的血清学组合与 CMV 感染的发展独立相关。本研究获得的数据揭示了对 LT 受者进行管理以预防严重细菌感染、IA 和 CMV 感染的证据。