Influencing factors of multi-drug resistant Acinetobacter baumannii infection in patients after liver transplantation

Abstract

Objective To explore the multi-drug resistance condition and independent risk factors of Acinetobacter baumannii infection in patients after liver transplantation. Methods Clinical data of 257 patients who underwent liver transplantation in Shanghai General Hospital between January 2010 and June 2015 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Twenty-five patients were infected with multi-drug resistant Acinetobacter baumannii. Among the patients, 17 were males and 8 were females, 10 were younger than 50 years old and 15 were older or equal to 50 years old. Drug sensitive test was detected using concentration gradient method, metallo-beta-lactamase was detected using composite paper, and bacterial genotype was detected using repetitive sequence polymerase chain reaction (PCR) and gel electrophoresis. Drug resistance, drug-resistant spectrum, genotype distribution, infection time and influence factors of infection for multi-drug resistant Acinetobacter baumannii were observed and analyzed. Single-factor analysis of multi-drug resistant Acinetobacter baumannii was conducted using Chi-square test and multiple-factor analysis was conducted using logistic regression analysis. Results The incidence of multi-drug resistant Acinetobacter baumannii infection was 9.7%(25/257). Acinetobacter baumannii strains were highly resistant to aminoglycosides, quinolones, penicillins, cephalosporins and carbapenems, with the drug resistance of 100%. In addition, 96%(24/25) of the strains were metallo-beta-lactamase positive. Three genotypes were observed in the 25 strains of Acinetobacter baumannii: type B (n=18), type A (n=5) and type C (n=2). Positive postoperative fungal culture (OR=5.470, 95%CI: 1.402-21.333, P<0.05) and re-intubation (OR=11.538, 95%CI: 2.228-59.742, P<0.05) were the independent risk factors for multi-drug resistant Acinetobacter baumannii infection. Conclusions The incidence of multidrug-resistant Acinetobacter baumannii infection in patients after liver transplantation is high. Multidrug-resistant Acinetobacter baumannii is highly resistant to multiple antibiotics, and type B is the main genetype. Positive postoperative fungal culture and re-intubation are the independent risk factors for multi-drug resistant Acinetobacter baumannii infection. Key words: Liver transplantation; Multidrug resistance-associated proteins; Acinetobacter baumannii; Infection