Analysis Of Gram-positive Bacterial Infectionin Patients With Liver Transplantation

ObjectiveUnderstanding the molecular epidemiology and influencing factors of multidrug-resistant gram-positive infection in patients with liver transplantation, to provide reference for clinic treatment and prevention of gram-positive bacterial infection.MethodsWe isolated and detected the bacteria from phlegm, throat swabs, urine, wound or wound secretions, blood and defecate samples in221cases of patients with liver transplantation in our hospital in January2007～April2010. All the isolated bacteria was made strains identified and tested by Minimal Inhibitory Concentration(MIC) drug sensitive detection through BioMerieux ATB bacterial identification instrument; REP-PCR detection of bacterial homology. All the risk factors were made by multivariate logistic regression analysis.ResultsIn221patients with liver transplant hospitalized, we collected250specimens in the cases, Of those,29patients developed multiple infections.65strains of gram-positive bacteria were isolated from the specimens of the different parts in53cases of infectious patients. We detected29multidrug-resistant gram-positive strains from29cases of patients (44.62%):Including20strains of staphylococcus aureus (68.97%),9enterococcus (31.03%).20Staphylococcus aureus are highly resistant toaminoglycosides(gentamicin),cephalosporins(cefoxitin),quinolones(ciprofloxacin,le vofloxacin),lincomycins(clindamycin),penicillin,erythromycin act, The resistance rates was up to100%.20Staphylococcus aureus are highly sensitive to vancomycin and oxazolidinone (linezolid), both MIC50<2ug/ml.9enterococci were also highly resistant to aminoglycosides, quinolones, penicillins and highly sensitive to vancomycin(MIC50<2ug/ml)and oxazolidinone (MIC50<1ug/ml).By REP-PCR detection, Staphylococcus aureus was divided into5genotypes,in Which has14B-type strains. Enterococcus was divided into11genotypes, in Which had2D-type strains,2G-type strains and2K-type strains.The risk factor of gram-positive bacteria infection in patients with liver transplantation was use of antibiotics preoperative (OR=3.949, p=0.004),too much blood input intraoperativ (OR=1.071,p=0.005) and renal failure postoperative OR=5.427, P=0.043)ConclusionsStaphylococcus aureus and enterococcus were the main pathogens infecting after liver transplantation in patients with drug-resistant gram-positive bacteria infection. And its resistance to multiple antibiotics was widely. B-type strains of staphylococcus aureus was the predominant type. Reasonable use of antibiotics, decreasing blood input intraoperative and preventing renal failure postoperative may reduce the gram-positive bacterial infections and drug resistant strains appearing after liver transplantation.