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Master Thesis

Infections a bactéries multirésistantes chez les transplantes hépatiques : facteurs prédictifs et impact sur le pronostic

Abstract : Introduction: The liver transplant recipients, in relation to the Long-term immunosuppressive regimenare at greater risk of infection, mainly from bacterial episodes in the early period. There are associated with an increasing morbidity and mortality. The prevalence of multidrug resistance is increasing and mainly depends on the center and country. The risk factors of multidrug-resistant bacterial (MRB) and related mortality among this population are poorly known. The available data are specific to a bacteria or an epidemiology. Methods: This was a retrospective observational, single center study at Paul Brousse Hospital (Paris) from 2014 to 2017. All consecutive patients transplanted during that period were recruited. Care protocol was documented and infection criteria well defined. The primary objective of our study was to evaluate the first-year mortality of patients who developed a MRB infections post-LT. Secondary aims were to assess the associated morbidity (hospitalization length-of-stay) and risks factors. We also watched for local epidemiology. Results: We recruited a total of 403 liver transplant recipients with mean age of 51.4 ± 14.7 years, of whom 65.3% were males. 147 patients (36.4%) developed at least one infectious episode. 50(12,4%) developed a multi-resistant bacterial strains (MRB). Median interval between transplant and the first infectious episode was 15 days. Of those patients with MRB, 82% had an ESBL Bacteria, 72% had Carbapénémases and 1,4% MRSA. The 1-year patient survival of those infected by MRB was significantly lower of those non-infected or infected with a non-BMR (76% vs. 96%; p<0, 0001). In the multivariate analysis, MRB infection was significantly associated with 1-year mortality (OR = 3.49 [95%CI 1.48-8.23], p=0.0041). MRB infection was significantly associated with increasing Intensive care unit (ICU) length-of-stay (34.1 ± 40.3 vs. 10.2 ± 11.6; p=0.0001), but not with an increase of total hospitalization length-of-stay (18.2 ± 16.2 vs. 153 ± 8.5; p=0.21). The multivariate analysis highlighted several risk factors significantly associated with MRB infection such as MRB colonization (OR=5,38 [95%CI 2,83-10,22], p< 0,0001), hepatic encephalopathy/coma (OR = 2.58, [95%CI 1.01-6.53]; p=0.046) prior to transplant and reintervention post-transplant (OR = 2.32 [95%CI 1.20-4.48]; p=0.012). Conclusion: Multibacterial resistant infection strongly impact 1-year patient survival after liver transplantation. MRB colonization, hepatic encephalopathy prior to transplant and surgical reintervention post-transplant were major risk factors associated with the development of MRB infection. It encourages to close monitoring of these patients prior and early after transplant and the utmost respect of sanitary rules and antibiotics therapy practices.
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https://dumas.ccsd.cnrs.fr/dumas-03121994
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Submitted on : Tuesday, January 26, 2021 - 5:40:50 PM
Last modification on : Wednesday, May 26, 2021 - 3:42:11 AM

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Jules Fatseas. Infections a bactéries multirésistantes chez les transplantes hépatiques : facteurs prédictifs et impact sur le pronostic. Hépatologie et Gastroentérologie. 2019. ⟨dumas-03121994⟩

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