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

肝移植(LT)术后感染发生率普遍较高，主要原因是技术复杂，且存在潜在的腹腔环境污染问题。本研究的主要目的是探讨添加益生菌和免疫营养素是否能降低LT的感染率。观察预防性抗菌药(ABPC和CTX)的变化对术后菌血症的影响，并探讨侵袭性曲霉病(IA)和巨细胞病毒(CMV)感染是LT术后严重和典型的机会性感染的危险因素。由于根据研究方案难以摄入益生菌和免疫营养素，登记人数不足以进行分析。然而，这些药物对肝移植受者的安全性是可以证明的，因此，我们计划通过修改后的方案进行额外的研究。菌血症发生率由前期(2000-02)的26.3/100LDLT下降到后期(03-06)的18.4。ABPC和CTX耐药菌引起的菌血症下降幅度(由15.1降至10.1)高于敏感菌(由11.2降至8.4)，其中MRSA(由5.0降至2.5)和肠球菌(由7.7降至4.5)明显减少。发生IA的危险因素为术前重症监护病房住院时间和术前应用类固醇。重型肝炎(FH)术前应用类固醇可能易导致肝移植后IA的发生。此外，多变量分析显示，FH是一种潜在疾病，ABO血型不合的LT，以及CMV阳性/受体阴性的供者/受者的血清学组合(D+/R-)与CMV感染的发生独立相关。通过这项研究获得的数据揭示了肝移植受者预防严重细菌感染、IA和CMV感染的管理证据。

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.