Multicenter expert consensus on prevention and treatment of infections caused by multi-drug resistant organisms after liver transplantation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Shouping ^1,2 , WANG Pusen ³ , Lü Tao ¹ , YANG Jian ¹ , KONG Lingxiang ¹ , XU Gang ¹ , SONG Jiulin ¹ , XIE Kunlin ¹ , ZHAO Dong ³ , QUE Weitao ³ , HUANG Yiming ³ , TANG Jianxin ³ , FANG Taishi ³ , JIANG Zhongyi ³ , GAO Wei ⁴ , DONG Chong ⁴ , CHEN Gang ⁵ , ZHU Lan ⁵ , GUO Wenzhi ⁶ , TAO Ruolin ⁶ , FU Zhiren ⁷ , SONG Shaohua ⁷ , CHEN Changbin ⁸ , WANG Yuanyuan ⁸ , YANG Liang ⁹ , LI Guangming ¹⁰ , YI Huimin ¹¹ , ZHANG Zhongwei ² ,  ZHONG Lin ³ ,  YANG Jiayin ¹

1. Liver Transplant Center, Organ Transplant Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of Critical Care Unit, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
3. Department of Liver Surgery and Organ Transplantation Center, Shenzhen Third People’s Hospital, Shenzhen, Guangdong 518112, P. R. China;
4. Department of Liver Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, Tianjin 300190, P. R. China;
5. Organ Transplantation Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, P. R. China;
6. Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, P. R. China;
7. Department of General Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, P. R. China;
8. Shanghai Institute of Immunity and Infection, Chinese Academy of Sciences, Shanghai 200031, P. R. China;
9. School of Medcine, Southern University of Science and Technology, Shenzhen, Guangdong 518055, P. R. China;
10. Department of Organ Transplantation, You’an Hospital, Capital Medical University, Beijing 100069, P. R. China;
11. Surgical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, P. R. China;

Corresponding?author：

ZHONG Lin, Email: zhonglin1@medmail.com.cn; YANG Jiayin, Email: doctoryjy@scu.edu.cn

Keywords：

liver transplantation; multi-drug resistant organisms; infection; carbapenem-resistant; antibiotic

DOI：

10.7507/1007-9424.202501074

Video：

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Abstract Full text Figures/Tables Video References Cited by

Liver transplantation is a most curative treatment for end-stage liver diseases. However, postoperative infection, especially the multi-drug resistant organisms infection, could contribute to the mortality after liver transplantation. Therefore, how to identify and prevent multi-drug resistant bacterial infection is the key to achieve improved postoperative outcomes after liver transplantation. The team of West China Hospital of Sichuan University, in collaboration with multiple Chinese medical centers, draw on the mature experiences of advanced countries in the field of transplantation jointly formulated the “Multicenter expert consensus on prevention and treatment of infections caused by multi-drug resistant organisms after liver transplantation”. The consensus had been developed around aspects such as epidemiological characteristics, antimicrobial uses, and prevention measurements of multi-drug resistant bacterial infection after liver transplantation.

Citation： WANG Shouping, WANG Pusen, Lü Tao, YANG Jian, KONG Lingxiang, XU Gang, SONG Jiulin, XIE Kunlin, ZHAO Dong, QUE Weitao, HUANG Yiming, TANG Jianxin, FANG Taishi, JIANG Zhongyi, GAO Wei, DONG Chong, CHEN Gang, ZHU Lan, GUO Wenzhi, TAO Ruolin, FU Zhiren, SONG Shaohua, CHEN Changbin, WANG Yuanyuan, YANG Liang, LI Guangming, YI Huimin, ZHANG Zhongwei, ZHONG Lin, YANG Jiayin. Multicenter expert consensus on prevention and treatment of infections caused by multi-drug resistant organisms after liver transplantation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(1): 1-8. doi: 10.7507/1007-9424.202501074 Copy

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4.	Shafiekhani M, Mirjalili M, Vazin A. Prevalence, risk factors and treatment of the most common gram-negative bacterial infections in liver transplant recipients: A review. Infect Drug Resist, 2019, 12: 3485-3495.
5.	Righi E. Management of bacterial and fungal infections in end stage liver disease and liver transplantation: Current options and future directions. World J Gastroenterol, 2018, 24(38): 4311-4329.
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7.	Kalpoe JS, Sonnenberg E, Factor SH, et al. Mortality associated with carbapenem-resistant Klebsiella pneumoniae infections in liver transplant recipients. Liver Transpl, 2012, 18(4): 468-474.
8.	Zhong L, Men TY, Li H, et al. Multidrug-resistant gram-negative bacterial infections after liver transplantation—spectrum and risk factors. J Infect, 2012, 64(3): 299-310.
9.	Martin-Mateos R, Martínez-Arenas L, Carvalho-Gomes á, et al. Multidrug-resistant bacterial infections after liver transplantation: Prevalence, impact, and risk factors. J Hepatol, 2024, 80(6): 904-912.
10.	Freire MP, Pierrotti LC, Oshiro IC, et al. Carbapenem-resistant Acinetobacter baumannii acquired before liver transplantation: Impact on recipient outcomes. Liver Transpl, 2016, 22(5): 615-626.
11.	Taimur S, Pouch SM, Zubizarreta N, et al. Impact of pre-transplant carbapenem-resistant Enterobacterales colonization and/or infection on solid organ transplant outcomes. Clin Transplant, 2021, 35(4): e14239. doi: 10.1111/ctr.14239.
12.	Ferstl PG, Filmann N, Heilgenthal EM, et al. Colonization with multidrug-resistant organisms is associated with in increased mortality in liver transplant candidates. PLoS One, 2021, 16(1): e0245091. doi: 10.1371/journal.pone.0245091.
13.	Pereira MR, Scully BF, Pouch SM, et al. Risk factors and outcomes of carbapenem-resistant Klebsiella pneumoniae infections in liver transplant recipients. Liver Transpl, 2015, 21(12): 1511-1519.
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17.	Li H, Yu DL, Ren L, et al. Analysis of Gram-positive bacterial infection in patients following liver transplantation. Chin Med J (Engl), 2012, 125(14): 2417-2421.
18.	林吉, 黃文治, 喬甫. 肝移植患者術后耐碳青霉烯類革蘭陰性菌感染的影響因素分析. 中華醫院感染學雜志, 2020, 30(4): 621-625.
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22.	申存毅, 王婧, 林婷, 等. 肝移植術后多重耐藥菌感染分布特征及危險因素. 肝膽胰外科雜志, 2020, 32(6): 355-360.
23.	劉夢元, 方芳. 肝移植后多重耐藥菌感染的相關危險因素. 中國組織工程研究, 2019, 23(7): 1109-1114.
24.	楊進, 惠娜, 王九萍, 等. 肝移植術后多重耐藥菌感染危險因素的Meta分析. 中華現代護理雜志, 2024, 30(29): 3980-3986.
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26.	Avkan-Oguz V, Ozkardesler S, Unek T, et al. Risk factors for early bacterial infections in liver transplantation. Transplant Proc, 2013, 45(3): 993-997.
27.	李文磊, 武聚山, 賈哲, 等. 肝移植術后耐碳青霉烯肺炎克雷伯菌感染危險因素分析. 中華移植雜志(電子版), 2021, 15(6): 347-352.
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29.	Zeng M, Xia J, Zong Z, et al. Guidelines for the diagnosis, treatment, prevention and control of infections caused by carbapenem-resistant Gram-negative bacilli. J Microbiol Immunol Infect, 2023, 56(4): 653-671.
30.	中華醫學會器官移植學分會. 器官移植術后耐藥菌感染診療技術規范(2019版). 器官移植, 2019, 10(4): 352-358.
31.	Bonomo RA, Chow AW, Edwards MS, et al. 2024 clinical practice guideline update by the Infectious Diseases Society of America on complicated intra-abdominal infections: Risk assessment, diagnostic imaging, and microbiological evaluation in adults, children, and pregnant people. Clin Infect Dis, 2024, 79(Supplement_3): S81-S87. doi: 10.1093/cid/ciae346.
32.	中國醫師協會器官移植醫師分會, 中華醫學會器官移植學分會. 中國實體器官移植手術部位感染管理專家共識(2022版). 器官移植, 2023, 14(1): 11-23,48.
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36.	Soriano A, Carmeli Y, Omrani AS, et al. Ceftazidime-avibactam for the treatment of serious Gram-negative infections with limited treatment options: A systematic literature review. Infect Dis Ther, 2021, 10(4): 1989-2034.
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1. Resino E, San-Juan R, Aguado JM. Selective intestinal decontamination for the prevention of early bacterial infections after liver transplantation. World J Gastroenterol, 2016, 22(26): 5950-5957.
2. Weiss N, Thabut D. Neurological complications occurring after liver transplantation: Role of risk factors, hepatic encephalopathy, and acute (on chronic) brain injury. Liver Transpl, 2019, 25(3): 469-487.
3. Heldman MR, Ngo S, Dorschner PB, et al. Pre- and post-transplant bacterial infections in liver transplant recipients. Transpl Infect Dis, 2019, 21(5): e13152. doi: 10.1111/tid.13152.
4. Shafiekhani M, Mirjalili M, Vazin A. Prevalence, risk factors and treatment of the most common gram-negative bacterial infections in liver transplant recipients: A review. Infect Drug Resist, 2019, 12: 3485-3495.
5. Righi E. Management of bacterial and fungal infections in end stage liver disease and liver transplantation: Current options and future directions. World J Gastroenterol, 2018, 24(38): 4311-4329.
6. van Delden C, Stampf S, Hirsch HH, et al. Burden and timeline of infectious diseases in the first year after solid organ transplantation in the Swiss transplant cohort study. Clin Infect Dis, 2020, 71(7): e159-e169. doi: 10.1093/cid/ciz1113.
7. Kalpoe JS, Sonnenberg E, Factor SH, et al. Mortality associated with carbapenem-resistant Klebsiella pneumoniae infections in liver transplant recipients. Liver Transpl, 2012, 18(4): 468-474.
8. Zhong L, Men TY, Li H, et al. Multidrug-resistant gram-negative bacterial infections after liver transplantation—spectrum and risk factors. J Infect, 2012, 64(3): 299-310.
9. Martin-Mateos R, Martínez-Arenas L, Carvalho-Gomes á, et al. Multidrug-resistant bacterial infections after liver transplantation: Prevalence, impact, and risk factors. J Hepatol, 2024, 80(6): 904-912.
10. Freire MP, Pierrotti LC, Oshiro IC, et al. Carbapenem-resistant Acinetobacter baumannii acquired before liver transplantation: Impact on recipient outcomes. Liver Transpl, 2016, 22(5): 615-626.
11. Taimur S, Pouch SM, Zubizarreta N, et al. Impact of pre-transplant carbapenem-resistant Enterobacterales colonization and/or infection on solid organ transplant outcomes. Clin Transplant, 2021, 35(4): e14239. doi: 10.1111/ctr.14239.
12. Ferstl PG, Filmann N, Heilgenthal EM, et al. Colonization with multidrug-resistant organisms is associated with in increased mortality in liver transplant candidates. PLoS One, 2021, 16(1): e0245091. doi: 10.1371/journal.pone.0245091.
13. Pereira MR, Scully BF, Pouch SM, et al. Risk factors and outcomes of carbapenem-resistant Klebsiella pneumoniae infections in liver transplant recipients. Liver Transpl, 2015, 21(12): 1511-1519.
14. 中華人民共和國衛生部. 多重耐藥菌醫院感染預防與控制技術指南(試行). 中國危重病急救醫學, 2011, 23(2): 65.
15. Stephanie M Pouch 1, Gopi Patel 2; AST Infectious Diseases Community of Practice. Multidrug-resistant Gram-negative bacterial infections in solid organ transplant recipients—Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant, 2019, 33(9): e13594. doi: 10.1111/ctr.13594.
16. 王東, 周順, 王勇, 等. 肝移植術后多重耐藥菌感染特點及危險因素分析. 中華肝膽外科雜志, 2023, 29(9): 646-650.
17. Li H, Yu DL, Ren L, et al. Analysis of Gram-positive bacterial infection in patients following liver transplantation. Chin Med J (Engl), 2012, 125(14): 2417-2421.
18. 林吉, 黃文治, 喬甫. 肝移植患者術后耐碳青霉烯類革蘭陰性菌感染的影響因素分析. 中華醫院感染學雜志, 2020, 30(4): 621-625.
19. Hara T, Soyama A, Takatsuki M, et al. The impact of treated bacterial infections within one month before living donor liver transplantation in adults. Ann Transplant, 2014, 19: 674-679.
20. 談宜斌, 金學蘭, 李源, 等. 肝移植術后醫院感染流行病學分析. 中華器官移植雜志, 2018, 39(10): 592-596.
21. 韓鐸, 何宏, 王宏偉, 等. 肝移植術后感染病原菌分布及耐藥性分析. 臨床肝膽病雜志, 2023, 39(6): 1366-1373.
22. 申存毅, 王婧, 林婷, 等. 肝移植術后多重耐藥菌感染分布特征及危險因素. 肝膽胰外科雜志, 2020, 32(6): 355-360.
23. 劉夢元, 方芳. 肝移植后多重耐藥菌感染的相關危險因素. 中國組織工程研究, 2019, 23(7): 1109-1114.
24. 楊進, 惠娜, 王九萍, 等. 肝移植術后多重耐藥菌感染危險因素的Meta分析. 中華現代護理雜志, 2024, 30(29): 3980-3986.
25. 謝秀華, 姜英俊, 解曼, 等. 肝移植后早期受者發生感染的危險因素及病原學分析. 中華器官移植雜志, 2017, 38(4): 200-205.
26. Avkan-Oguz V, Ozkardesler S, Unek T, et al. Risk factors for early bacterial infections in liver transplantation. Transplant Proc, 2013, 45(3): 993-997.
27. 李文磊, 武聚山, 賈哲, 等. 肝移植術后耐碳青霉烯肺炎克雷伯菌感染危險因素分析. 中華移植雜志(電子版), 2021, 15(6): 347-352.
28. Tamma PD, Heil EL, Justo JA, et al. Infectious Diseases Society of America 2024 Guidance on the treatment of antimicrobial-resistant Gram-negative infections. Clin Infect Dis, 2024 Aug 7: ciae403. doi: 10.1093/cid/ciae403.
29. Zeng M, Xia J, Zong Z, et al. Guidelines for the diagnosis, treatment, prevention and control of infections caused by carbapenem-resistant Gram-negative bacilli. J Microbiol Immunol Infect, 2023, 56(4): 653-671.
30. 中華醫學會器官移植學分會. 器官移植術后耐藥菌感染診療技術規范(2019版). 器官移植, 2019, 10(4): 352-358.
31. Bonomo RA, Chow AW, Edwards MS, et al. 2024 clinical practice guideline update by the Infectious Diseases Society of America on complicated intra-abdominal infections: Risk assessment, diagnostic imaging, and microbiological evaluation in adults, children, and pregnant people. Clin Infect Dis, 2024, 79(Supplement_3): S81-S87. doi: 10.1093/cid/ciae346.
32. 中國醫師協會器官移植醫師分會, 中華醫學會器官移植學分會. 中國實體器官移植手術部位感染管理專家共識(2022版). 器官移植, 2023, 14(1): 11-23,48.
33. 何紅, 黃紫嫣, 陶曉燕, 等. 耐碳青霉烯類肺炎克雷伯菌產酶耐藥機制及同源性分析. 中華醫院感染學雜志, 2021, 31(3): 326-331.
34. Lan P, Jiang Y, Zhou J, et al. A global perspective on the convergence of hypervirulence and carbapenem resistance in Klebsiella pneumoniae. J Glob Antimicrob Resist, 2021, 25: 26-34.
35. 袁瑾懿, 林東昉. 美國感染病學會對產超廣譜β內酰胺酶腸桿菌目細菌、碳青霉烯類耐藥腸桿菌目細菌和難治性耐藥銅綠假單胞菌的治療指導原則. 中國感染與化療雜志, 2021, 21(5): 633-638.
36. Soriano A, Carmeli Y, Omrani AS, et al. Ceftazidime-avibactam for the treatment of serious Gram-negative infections with limited treatment options: A systematic literature review. Infect Dis Ther, 2021, 10(4): 1989-2034.
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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Multicenter expert consensus on prevention and treatment of infections caused by multi-drug resistant organisms after liver transplantation

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