Characteristics of Gram-positive cocci infection and the therapeutic effect after liver transplantation / 中南大学学报(医学版)

OBJECTIVES@#Gram-positive cocci is the main pathogen responsible for early infection after liver transplantation (LT), posing a huge threat to the prognosis of liver transplant recipients. This study aims to analyze the distribution and drug resistance of Gram-positive cocci, the risk factors for infections and efficacy of antibiotics within 2 months after LT, and to guide the prevention and treatment of these infections.@*METHODS@#In this study, data of pathogenic bacteria distribution, drug resistance and therapeutic efficacy were collected from 39 Gram-positive cocci infections among 256 patients who received liver transplantation from donation after citizens' death in the Third Xiangya Hospital of Central South University from January 2019 to July 2022, and risk factors for Gram-positive cocci infection were analyzed.@*RESULTS@#Enterococcus faecium was the dominant pathogenic bacteria (33/51, 64.7%), followed by Enterococcus faecalis (11/51, 21.6%). The most common sites of infection were abdominal cavity/biliary tract (13/256, 5.1%) and urinary tract (10/256, 3.9%). Fifty (98%) of the 51 Gram-positive cocci infections occurred within 1 month after LT. The most sensitive drugs to Gram-positive cocci were teicoplanin, tigecycline, linezolid and vancomycin. Vancomycin was not used in all patients, considering its nephrotoxicity. Vancomycin was not administered to all patients in view of its nephrotoxicity.There was no significant difference between the efficacy of daptomycin and teicoplanin in the prevention of cocci infection (P>0.05). Univariate analysis indicated that preoperative Model for End-Stage Liver Disease (MELD) score >25 (P=0.005), intraoperative red blood cell infusion ≥12 U (P=0.013) and exposure to more than 2 intravenous antibiotics post-LT (P=0.003) were related to Gram-positive cocci infections. Multivariate logistic regression analysis revealed that preoperative MELD score >25 (OR=2.378, 95% CI 1.124 to 5.032, P=0.024) and intraoperative red blood cell transfusion ≥ 12 U (OR=2.757, 95% CI 1.227 to 6.195, P=0.014) were independent risk factors for Gram-positive cocci infections after LT. Postoperative Gram-positive cocci infections were reduced in LT recipients exposing to more than two intravenous antibiotics post-LT (OR=0.269, 95% CI 0.121 to 0.598, P=0.001).@*CONCLUSIONS@#Gram-positive cocci infections occurring early after liver transplantation were dominated by Enterococcus faecalis infections at the abdominal/biliary tract and urinary tract. Teicoplanin, tigecycline and linezolid were anti-cocci sensitive drugs. Daptomycin and teicoplanin were equally effective in preventing cocci infections due to Gram-positive cocci. Patients with high preoperative MELD score and massive intraoperative red blood cell transfusion were more likely to suffer Gram-positive cocci infection after surgery. Postoperative Gram-positive cocci infections were reduced in recipients exposing to more than two intravenous antibiotics post-LT.

Research advances on the role of Na +-K +-ATPase regulation in pulmonary edema clearance of acute respiratory distress syndrome / 中华危重病急救医学

Acute respiratory distress syndrome (ARDS) is a critical disease with high mortality, and currently there is no specific treatment. ARDS is characterized by refractory hypoxemia secondary to pulmonary edema, but the underlying mechanism is not yet fully understood. Alveolar edema fluid is mainly actively transported and reabsorbed by sodium-water transport system. The sodium pump (Na +-K +-ATPase-mediated Na + transport) on the basal side of type Ⅱ alveolar epithelial cells (ATⅡ) is the main driving force for pulmonary edema clearance. Na +-K +-ATPase regulation is affected by many regulatory factors through a variety of ways, among which "long-term regulation" mechanism plays an important role, including positively regulating the gene transcription and protein expression of Na +-K +-ATPase. Na +-K +-ATPase can also be degraded by ubiquitin-proteasome pathway (UPP) and autophagy lysosome pathway to affect its abundance and enzyme activity, meanwhile, Na +-K +-ATPase α1 plays a key role in sodium water transport. We review the "long-term regulation" mechanism of Na +-K +-ATPase related pathways in pulmonary edema clearance and explore the possibility of new therapies for ARDS based on this mechanism, so as to provide new targets for the treatment of ARDS.

Correlation analysis between red cell volume distribution width and the mortality rate in ARDS patients after renal transplantation / 器官移植

Objective To investigate the correlation between red cell volume distribution width (RDW) and the mortality rate of acute respiratory distress syndrome (ARDS) patients after renal transplantation. Methods Clinical data of 106 ARDS patients undergoing renal transplantation were retrospectively analyzed. According to RDW, all patients were assigned into the normal (≤15.0%, n=68) and increasing RDW groups (>15.0%, n=38). Baseline data and the incidence of adverse events were statistically compared between two groups. Kaplan-Meier survival curve was adopted to compare the 50 d-mortality rate between two groups. Cox's proportional hazards regression model was utilized to identify the risk factors of the mortality of ARDS patients. Results Among 106 patients, the 50 d-mortality rate was calculated as 43.4% (46/106). The sequential organ failure assessment (SOFA) score, serum creatinine, hemoglobin and platelet count significantly differed between two groups (all P<0.05). In the increasing RDW group, the 50 d-mortality rate and the incidence of infectious shock were significantly higher than those in the normal RDW group (both P<0.05). Kaplan-Meier survival curve demonstrated that the 50 d-mortality rate significantly differed between two groups (P<0.01). Cox's proportional hazards regression model univariate analysis revealed that hemoglobin level<100 g/L, serum creatinine>133 μmol/L, platelet count<100×109/L, severe ARDS and RDW>15.0% were the potential risk factors of the 50 d-mortality rate in ARDS patients (all P<0.05). Multivariate analysis demonstrated that severe ARDS [odd ratio (OR)=12.77, 95%confidence interval (CI) 11.63-15.39, P<0.001] and RDW>15.0% (OR=2.01, 95%CI 1.02-3.94, P<0.043) were the independent risk factors of the 50 d-mortality rate in ARDS patients. Conclusions RDW elevation is correlated with the severity of disease and 50 d-mortality rate in ARDS patients following renal transplantation. RDW can serve as a clinical parameter to predict the prognosis of ARDS patients after renal transplantation.

Visualization analysis of research highlights and frontiers in deceased organ donation from 2006 to 2016 / 器官移植

To investigate the research focuses and developmental trends of deceased organ donation by visualization analyzed in English literatures data from 2006 to 2016.Methods The research strength,high impact authors,core journals,high frequency keywords and burst terms related to deceased organ donation from the Web of Science database were statistically analyzed by using CiteSpace.Results A total of 1 278 relevant literatures revealed that the research strength was mainly distributed in the United States with a total quantity of 497 papers,accounting for 28％ of the total quantity from 2006 to 2016.Both Ploeg RJ and Parrilla P published 14 papers.The paper written by Kootstra G was the most cited for 192 times.The papers published in Am J Transplant were cited for 917 times.The high frequency keywords included organ donation,transplantation,donation,etc.The high frequency burst terms included waiting-list,beating donor,donor-kidneys,etc.Conclusions In recent decade,the research highlights of deceased organ donation mainly include survival rate of transplantation with donation after cardiac death,prognosis of transplantation with deceased organ donation and preservation techniques of donor organ in deceased organ donation,etc.The research frontiers focus on deceased organ donation rates,the source of donor organ,standard and extended standard of deceased organ donation,etc.

Risk factors of bloodstream infection-related death after liver transplantation / 中华消化外科杂志

Objective To investigate the risk factors of bloodstream infection-related death after liver transplantation.Methods The retrospective case-control study was adopted.The clinical data of the 107 patients with bloodstream infection from 365 liver transplantation patients who were admitted to the Third Xiangya Hospital of Central South University (220 patients) and South Central Hospital Affiliated to Wuhan University (145 patients) from January 1,2002 to December 31,2015 were collected.The patients received modified piggyback liver transplantation.The second or third generation celphalosporin or carbapenems antibiotics were preventively used against infection according to the bacterial culture results before surgery,and the immune inhibitor basic program after surgery was FK506 + prednisone.The observation indicators included:(1) the bloodstream infection status after liver transplantation:incidence of bloodstream infection,frequency of bloodstream infection,inadequate antiinfection treatment,primary infection position,microorganism infection type,bacterial culture results and bloodstream infection-related mortality.(2) The risk factors of blood stream infection-related death after liver transplantation in univariate and multivariate analyses in cluded:the gender,age,resource of donor,usage of immune inhibitor,time between infection and liver transplantation,infection temperature,primary infection position(intraperitoneal or biliary infection),pathogenic microorganism type,nosocomial infection,inadequate antibiotic usage,serum creatinine level,serum albumin (Alb) level,white blood cell (WBC) in peripheral blood,lymphocyte in peripheral blood,platelet (PLT) in peripheral blood and septic shock indexes.The patients were followed up by outpatient examination and telephone interview up to January 31,2016,the follow-up contents included the survival status of the patients,vital signs,using status of immune inhibitor,immune inhibitor concentration,blood routine,biochemical indexes,surgery,other infection-related complications and acute rejection.Continuous variables with normal distribution were represented as ~ ± s.The univariate analysis was done by the Chi-square test.The multivariate analysis was done by the Logistic regression model.Results (1) The bloodstream infection status after liver transplantation:186 bloodstream infections were happened in 107 patients undergoing liver transplantation,with a total incidence of bloodstream infection of 29.32％ (107/365).The incidence of bloodstream infection was 28.18％ (62/220) in the Third Xiangya Hospital of Central South University and 31.03％ (45/145) in the South Central Hospital Affiliated to Wuhan University,with no statistical difference (x2=0.186,P ＞0.05).Of 107 patients,56 patients had once bloodstream infection,31 had twice bloodstream infection and 20 had three times or more bloodstream infection (frequency of the most bloodstream infection was 6).The inadequate anti-infection treatment was applied to the 41.12％ (44/107)of patients with liver transplantation and bloodstream infection.The number of patients with primary infection positions in abdomen,lung,urethra,intravascular catheter and unknown sites were 40,39,3,1 and 24,respectively.The Gram positive bacteria,Gram negative bacteria,fungus and mixed infection of microorganism infection type were detected in 28,24,4 and 51 patients,respectively.There were 102 patients with nosocomial infection.Bacteria culture results in 186 strains of blood sample illustrated:84 strains were Gram positive bacteria as major pathogenic bacteria,among which enterococcus (31 strains) and staphylococcus aureus (23 strains) were dominant strains.The bloodstream infection-related mortality was 37.38％ (40/107),including 35 patients dying of septic shock.(2) The univariate analysis showed that the gender,resource of the donor,infection temperature,type of microorganism,serum creatinine level,serum Alb level,WBC in peripheral blood,PLT in peripheral blood and septic shock were the risk factors affecting bloodstream infection-related death after liver transplantation (x2=5.801,5.920,13.047,12.776,11.366,7.976,25.173,9.289,51.905,P ＜0.05).The multivariate analysis showed that serum Alb level ＜ 30 mg/L and septic shock were the independent risk factors affecting bloodstream infection-related death after liver transplantation (OR =5.839,44.983,95 ％ confidence interval:1.145-29.767,12.606-160.514,P ＜ 0.05).Conclusion It is prone to happen bloodstream infection after liver transplantation,and serum Alb level ＜ 30mg/L and septic shock are the independent risk factors affecting bloodstream infection-related death after liver transplantation.

Manifestation, distribution of pathogen, and resistance of bloodstream infections after renal transplantation：clinical anylasis of 71 patients / 中南大学学报(医学版)

Objective:To investigate the clinical manifestation and determine the distribution of pathogens and their characteristics of drug susceptibility to bloodstream infections (BSIs), and provide evidence for clinical anti-infection treatments after renal transplantation. Methods:Totally 81 episodes of BSIs occurred in 71 patients between July 2003 and June 2013. We retrospectively analyzed the pathogens and their drug susceptibility characteristics with BD microbiological assay system. We also collected the clinical and laboratory data of the patients . Results:The main pathogens were gram negative bacteria (67.90%), followed by gram positive bacteria (28.40%) and fungi (3.70%). The most common gram negative bacillus was Escherichia coli.While for gram positive bacteria, the main bacillus was coagulase-negative staphylococci. The gram negative bacteria were relatively sensitive to aminoglycosides and carbapenem. The gram positive bacteria were sensitive to glycopeptides and oxazolidone. Conclusion:The clinical manifestations included high body temperature, onset in the early period after kidney transplantation and high mortality. Though gram positive coccus plays an important role, most infections are caused by gram negative bacteria in BSIs after the renal transplantation. The antibiotic resistant rate for gram negative bacteria is very high as well as gram positive bacteria.

Risk factors for bloodstream infections in liver or kidney transplantation recipients / 中南大学学报(医学版)

OBJECTIVE@#To investigate the possible risk factors for death among liver or kidney recipients with bloodstream infections (BSIs).@*METHODS@#A retrospective study of 138 episodes of bloodstream infections documented in 103 patients was conducted to assess potential risk factors for mortality. The risk factors were identified by logistic regression analysis.@*RESULTS@#The mean age of the patients was 12-66 (42.3±12.7) years. The majority of infections were nosocomial (78.6%). The BSIs-related mortality rate was 39.8% (41/103). The following variables were identified as risk factors for BSIs-related mortality by univariate analysis: intraabdominal/ biliary focus (P=0.003), polymicrobial infection (P<0.001), liver transplant (P<0.001), platelet count <50000/mm3 (P<0.001), and septic shock (P<0.001). Platelet count < 50000/mm3 (P=0.002) and septic shock (P<0.001) showed significantly difference between the mortality group and the survival groups in the multivariate logistic regression analysis.@*CONCLUSION@#Decreased platelet count and septic shock are risk factors for increased

Risk factors for septic shock in patients with solid organ transplantation and complication of bacteremias / 中南大学学报(医学版)

OBJECTIVE@#To explore the risk factors for septic shock in patients with solid organ transplantation and complication of bacteremias.@*METHODS@#Clinical data of 98 solid organ transplant cases with complication of bacteremias were retrospectively studied. All episodes of bacteremias met the CDC criteria. Six possible risk factors contributing to septic shock were evaluated by univariate analysis and multivariate logistic regression analysis.@*RESULTS@#Among the 98 patients, 133 times of bacteremias have been reported and 39 patients developed septic shock. Among the 39 patients with septic shock, 43.5%, 38.5%, 15.4% and 2.6% of bacteremias were induced by multiple bacteria, gram-negative bacteria, gram-positive bacteria and fungi, respectively. The lung was the main source of bacteremias (41.8%), followed by intraabdominal/ biliary focus (24.5%). Risk factors for developing septic shock included the bacteremias happened in the 2nd to 8th week post transplant (P=0.014), polymicrobial etiology (P=0.001), intra-abdominal/ biliary focus (P=0.011), and liver transplant (P=0.002). Only bacteremias occurred in the 2nd to 8th week post transplant and polymicrobial etiology were significant risk factors by multivariate analysis.@*CONCLUSION@#Risk factors for developing septic shock in bacteremias after SOT are early-onset (the 2nd-8th week post transplant) and polymicrobial etiology.

A clinical analysis of 96 patients with bloodstream infections after solid organ transplantation / 中南大学学报(医学版)

OBJECTIVE@#To evaluate clinical characteristics, pathogens, treatment regimens and outcomes in patients with bloodstream infections (BSIs) after solid organ transplantation.@*METHODS@#Clinical data of ninety six cases of BSI were analyzed retrospectively to identify the pathogens and the origin of infection, and to evaluate comprehensive treatment and the causes of success or failure.@*RESULTS@#All 96 patients underwent the comprehensive treatments, including suspending administration of immunosuppressants and starting administration of appropriate antibiotics. The clinical characteristics of patients with BSIs after solid organ transplantation were atypical. The pathogens were various and seriously multi-drug resistant, which led to a high mortality. Among them 57 cases recovered, but the BSI-related mortality rate was 40.6%.@*CONCLUSION@#Stopping the administration of immunosuppressants, reasonable use of antibiotics, nutritional support and protecting the function of organs as soon as possible were of the greatest importance among of the various treatment plan. Avoidance of all kinds of infection in the first place is most important.

Clinical analysis of 48 cases of kidney transplantation from cardiac death donors / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the recovery of patients with end-stage renal disease (ESRD) receiving kidney transplant from cardiac death donors, and to assess graft survival in China from this type of donor.@*METHODS@#A total of 48 cases of patients with ESRD have received the kidneys from cardiac death donors in our hospital between February 2010 and March 2012. We retrospectively analyzed data on the preoperative and postoperative serum creatinine concentrations, on the survival of recipients and allografts with a view to investigating prognoses after this type of kidney transplant.@*RESULTS@#Primary non-function (PNF) did not occur in any of the 48 recipients. Delayed graft function (DGF) occurred in 18 of 48 (37.5%) of kidneys from cardiac death donors, but the occurrence of DGF did not adversely influence patient's survival (P=0.098) or graft survival (P=0.447). Seven of 48 (14.6%) recipients lost their graft. Over a median follow-up period of 8 months (range 0.5-23 months), 39 of 41(95.1%) recipients' graft function had fully recovered. The actuarial graft and patient's survival rates at 1, 3, 6 and 12 months after transplantation were 95.7%, 93.0%, 90.0%, 87.5%, and 100%, 94.9%, 90%, 87.5%, respectively.@*CONCLUSION@#As the legislation of donation after brain death (DBD) has not been ratified in China, the use of kidneys from cardiac death donors might be an effective way to increase the number of kidneys available for transplantation here. Our experience indicates good short- and mid-term outcomes with transplants from cardiac death donors.

Study on the reversion of drug resistance in clinical isolates of E. Coli by EGS technique / 中华传染病杂志

Objective To explore the potential of converting the chloramphenicol resistant clinical E. Coli isolates to chloramphenicol sensitive ones by employing external guide sequence(EGS) technique in vitro. Methods Recombinant plasmids with EGScat 1+2 and tetracycline resistant gene, named PAlterl EGScat1+2, was constructed. Routine Cacl 2 method was used to introduce recombinant plasmid into the chloramphenicol resistant clinical isolates E. Coli 4758. Colony PCR was used to test and A600 was used to detect growth rates in liquid and solid culture of various concentrations of chloramphenicol. Results The chloramphenicol resistant clinical isolates E. Coli 4758 grew well in chloramphenicol(35 ?g/ml, 70 ?g/ml, 105 ?g/ml, 170 ?g/ml) plates whereas the transformants tE4758 with PAlter1 EGScat 1+2 failed to grow in these concentrations, which indicated its resistance to the chloramphenicol was reversed. Conclusions EGS molecules are able to convert the drug resistance in clinical E. Coli isolates in vitro.