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©The Author(s) 2024.
World J Hepatol. Apr 27, 2024; 16(4): 612-624
Published online Apr 27, 2024. doi: 10.4254/wjh.v16.i4.612
Published online Apr 27, 2024. doi: 10.4254/wjh.v16.i4.612
Table 1 Demographic, laboratory, and clinical variables of 406 liver transplantation recipients
Characteristics | Value |
Recipient age (yr), mean ± SD | 47.3 ± 10.6 |
Recipient gender, no. of female (%) | 72 (17.7) |
Recipient BMI, median (IQR), kg/m2 | 22.8 (20.8-25.1) |
Hospital stay prior to LT, median (IQR), days | 10.0 (1.0-22.3) |
MELD score at LT, median (IQR) | 23.0 (15.0-30.0) |
Infection within 2 months prior to LT, n (%) | 160 (39.4) |
Pulmonary infection | 140 (34.5) |
Abdominal/biliary infection | 6 (1.5) |
Urinary tract infection | 1 (0.2) |
Multiple site infection1 | 13 (3.2) |
Pre-LT use of broad-spectrum antibiotics | 166 (40.9) |
Underlying liver diseases, n (%) | 406 (100) |
Viral cirrhosis/necrosis/tumor | 304 (74.9) |
Alcoholic cirrhosis | 31 (7.6) |
Autoimmune hepatitis | 15 (3.7) |
Primary biliary cirrhosis | 11 (2.7) |
Mixed cirrhosis | 19 (4.7) |
Others2 | 26 (6.4) |
Pre-LT type 2 diabetes, n (%) | 48 (11.8) |
Pre-LT creatinine, median (IQR), mg/dL | 0.8 (0.7-1.0) |
Pre-LT WBC count, median (IQR), × 109/L | 5.2 (3.4-8.1) |
Pre-LT lymphocyte count, median (IQR), × 109/L | 0.8 (0.5-1.2) |
Pre-LT platelet count, median (IQR), × 109/L | 72 (43.8-106.5) |
Pre-LT albumin level, median (IQR), g/L | 34.5 (30.9-38.1) |
Donor age (yr), mean ± SD | 42.1 ± 13.0 |
Steatosis ≥ 30%, n (%) | 42 (10.3) |
Cold ischemia time, mean ± SD | 6.2 ± 1.5 |
Duration of surgery, median (IQR), min | 378.5 (333.0-425.0) |
Intraoperative bleeding, median (IQR), mL | 3000.0 (2000.0-5000.0) |
Intraoperative RBC transfusion, median (IQR), units | 12.0 (8.0-18.0) |
Post-LT infections due to Klebsiella pneumoniae, n (%) | 32 (7.9) |
Post-LT infections due to CRKP, n (%) | 21 (5.2) |
Median interval between the onset of infections due to Klebsiella pneumoniae and LT, median (IQR), days | 7.5 (2.0-17.8) |
Post-LT immunosuppressant treatment, n (%) | 406 (100) |
Tacrolimus | 395 (97.3) |
Ciclosporin A | 5 (1.2) |
Mycophenolate mofetil/enteric-coated mycophenolate sodium | 277 (68.2) |
Sirolimus | 5 (1.2) |
Glucocorticoid | 406 (100) |
Basiliximab | 214 (52.7) |
Anti-thymocyte globulin | 18 (4.4) |
ALT on day 1 after LT, median (IQR), U/L | 694.5 (383.0-1242.0) |
Creatinine on day 3 after LT, median (IQR), mg/dL | 0.9 (0.7-1.4) |
Albumin level on day 1 after LT, median (IQR), g/L | 37.2 (33.9-40.7) |
Post-LT duration of urethral catheter, median (IQR), days | 3.0 (2.0-5.0) |
Post-LT mechanical ventilation, n (%) | 94 (23.2) |
Reoperation, n (%) | 17 (4.2) |
Acute rejection, n (%) | 67 (16.5) |
Post-LT renal replacement therapy, n (%) | 19 (4.7) |
ICU stay after LT, median (IQR), days | 6.0 (5.0-7.0) |
Hospitalization stay after LT, median (IQR), days | 26.0 (21.0-30.0) |
All-cause mortality within 6 months after LT, n (%) | 32 (7.9) |
Table 2 Infection sites of 44 episodes of infections caused by Klebsiella pneumoniae
Infection sites | Lung/thoracic cavity | Blood stream | Abdominal/biliary tract | Urinary tract | Perianal abscess | Liver abscess |
Klebsiella pneumoniae (44) | 15 | 12 | 12 | 3 | 1 | 1 |
Table 3 Rate of drug-resistance of 44 isolates of Klebsiella pneumoniae to 12 commonly used antibiotics, n (%)
Antimicrobial | n | Percentage |
TZP | 34 | 77.3 |
CAZ | 31 | 70.5 |
CFS | 30 | 68.2 |
FEP | 31 | 70.5 |
ATM | 31 | 70.5 |
MEM | 31 | 70.5 |
AN | 21 | 47.7 |
LVF | 33 | 75.0 |
SXT | 20 | 45.5 |
TIC | 10 | 22.7 |
POL | 1 | 2.3 |
CAZ/AVI | 1 | 2.3 |
Table 4 Univariate and multivariate logistic regression analysis of risk factors for infections due to Klebsiella pneumoniae within 3 months after liver transplantation, n (%)
Variables | With K. pneumoniae infections(32) | Without K. pneumoniae infections(374) | P value | OR (95%CI) |
Total | ||||
Univariate analysis | ||||
Female sex | 12 (37.5) | 60 (16.0) | 0.002 | |
Recipient age ≥ 55 yr | 10 (31.3) | 91 (24.3) | 0.385 | |
Recipient BMI ≥ 25 | 9 (28.1) | 97 (25.9) | 0.787 | |
MELD score at LT ≥ 22 | 23 (71.9) | 206 (55.1) | 0.066 | |
Hospital stay prior to LT ≥ 7 d | 23 (71.9) | 216 (57.8) | 0.119 | |
Viral cirrhosis/necrosis/tumor | 21 (65.6) | 283 (75.7) | 0.209 | |
Alcoholic cirrhosis | 3 (9.4) | 28 (7.5) | 0.969 | |
Pre-LT diabetes | 7 (21.9) | 41 (11.0) | 0.067 | |
Pre-LT use of broad-spectrum antibiotics ≥ 3 d | 16 (50.0) | 150 (40.1) | 0.275 | |
Pre-LT creatinine ≥ 2 mg/dL | 1 (3.1) | 28 (7.5) | 0.574 | |
Infection within 2 months prior to LT | 17 (53.7) | 143 (38.2) | 0.098 | |
Pre-LT WBC count ≥ 10 × 109/L | 4 (12.5) | 55 (14.7) | 0.937 | |
Pre-LT lymphocyte count ≤ 0.5 × 109/L | 6 (18.8) | 92 (24.6) | 0.458 | |
Pre-LT platelet count ≤ 50 × 109/L | 12 (37.5) | 123 (32.9) | 0.595 | |
Pre-LT albumin level < 30 g/L | 9 (28.1) | 71 (19.0) | 0.212 | |
Donor age ≥ 50 yr | 13 (40.6) | 121 (32.4) | 0.340 | |
Steatosis ≥ 30% | 2 (6.3) | 40 (10.7) | 0.624 | |
Cold ischemia time ≥ 360 min | 15 (46.9) | 189 (50.5) | 0.691 | |
Duration of surgery ≥ 450 min | 10 (31.3) | 61 (16.3) | 0.033 | |
Intraoperative bleeding ≥ 3000 mL | 23 (71.9) | 214 (57.2) | 0.101 | |
Intraoperative RBC transfusion ≥ 12 U | 20 (62.5) | 201 (53.7) | 0.340 | |
ALT on day 1 after LT ≥ 1500U/L | 14 (43.8) | 66 (17.6) | <0.001 | |
Creatinine on day 3 after LT ≥ 2 mg/dL | 4 (12.5) | 57 (15.2) | 0.874 | |
Albumin level on day 1 after LT < 30 g/L | 4 (12.5) | 24 (6.4) | 0.347 | |
Post-LT duration of urethral catheter ≥ 4 d | 22 (68.8) | 167 (44.7) | 0.009 | |
Post-LT mechanical ventilation | 13 (40.6) | 81 (21.7) | 0.015 | |
Reoperation | 3 (9.4) | 14 (3.7) | 0.286 | |
Acute rejection | 6 (18.8) | 61 (16.3) | 0.721 | |
Post-LT renal replacement therapy | 3 (9.4) | 16 (4.3) | 0.382 | |
Glucocorticoidse ≥ 1500 mg | 21 (65.6) | 235 (62.8) | 0.754 | |
Basiliximab use ≥ 40 mg | 14 (43.8) | 145 (38.8) | 0.580 | |
Anti-thymocyte globulin use | 4 (12.5) | 14 (3.7) | 0.063 | |
Multivariate analysis | ||||
Female sex | 0.012 | 2.827 (1.256-6.364) | ||
Pre-LT diabetes | 0.036 | 2.794 (1.070-7.294) | ||
ALT on day 1 after LT ≥ 1500U/L | 0.001 | 3.645 (1.671-7.950) | ||
Post-LT duration of urethral catheter ≥ 4 d | 0.046 | 2.266 (1.016-5.054) |
Table 5 The postoperative outcome for patients with/without infections caused by Klebsiella pneumoniae following liver transplantation, n (%)
Variables | With infections caused by K. pneumoniae(32) | Without infections caused by K. pneumoniae (374) | χ2 | P value |
ICU stay after LT ≥ 7 d | 18 (56.3) | 132 (35.3) | 5.557 | 0.018 |
Hospitalization stay after LT ≥ 21 d | 26 (81.3) | 302 (80.7) | 0.288 | 0.592 |
All-cause mortality within 6 months after LT | 6 (18.8) | 32 (8.6) | 5.651 | 0.017 |
Table 6 Univariate and multivariate Logistic regression analysis of risk factors for 6-month all-cause mortality after liver transplantation, n (%)
Variables | Death(32) | Survival(374) | P value | OR (95%CI) |
Total | ||||
Univariate analysis | ||||
Female sex | 10 (31.3) | 62 (16.6) | 0.037 | |
Recipient age ≥ 55 yr | 14 (43.8) | 87 (23.3) | 0.010 | |
Recipient BMI ≥ 25 | 4 (12.5) | 102 (27.3) | 0.068 | |
MELD score at LT ≥ 22 | 24 (75.0) | 205 (54.8) | 0.027 | |
Hospital stay prior to LT ≥ 7 d | 24 (75.0) | 215 (57.5) | 0.053 | |
Viral cirrhosis/necrosis/tumor | 25 (78.1) | 279 (74.6) | 0.659 | |
Alcoholic cirrhosis | 1 (3.1) | 30 (8.0) | 0.513 | |
Pre-LT diabetes | 4 (12.5) | 44 (11.8) | 1.000 | |
Pre-LT creatinine ≥ 2 mg/dL | 6 (18.8) | 23 (6.1) | 0.008 | |
Infection within 2 months prior to LT | 19 (59.4) | 141 (37.7) | 0.016 | |
Pre-LT WBC count ≥ 10 × 109/L | 7 (21.9) | 52 (13.9) | 0.219 | |
Pre-LT lymphocyte count ≤ 0.5 × 109/L | 12 (37.5) | 86 (23.0) | 0.066 | |
Pre-LT platelet count ≤ 50 × 109/L | 8 (25.0) | 127 (34.0) | 0.302 | |
Pre-LT albumin level < 30g/L | 6 (18.8) | 74 (19.8) | 0.888 | |
Donor age ≥ 50 yr | 7 (21.9) | 127 (34.0) | 0.163 | |
Steatosis ≥ 30% | 3 (9.4) | 39 (10.4) | 1.000 | |
Cold ischemia time ≥ 360 min | 20 (62.5) | 199 (53.2) | 0.248 | |
Duration of surgery ≥ 450 min | 8 (25.0) | 63 (16.8) | 0.244 | |
Intraoperative bleeding ≥ 3000 mL | 26 (81.3) | 211 (56.4) | 0.006 | |
Intraoperative RBC transfusion ≥ 12 U | 25 (78.1) | 196 (52.4) | 0.005 | |
ALT on day 1 after LT ≥ 1500 U/L | 8 (25.0) | 72 (19.3) | 0.433 | |
Creatinine on day 3 after LT ≥ 2 mg/dL | 18 (56.3) | 43 (11.5) | < 0.001 | |
Albumin level on day 1 after LT < 30 g/L | 6 (18.8) | 25 (6.7) | 0.564 | |
Post-LT infections due to Klebsiella pneumoniae | 6 (18.8) | 26 (7.0) | 0.017 | |
Post-LT infections due to CRKP | 6 (18.8) | 15 (4.0) | < 0.001 | |
Post-LT mechanical ventilation | 19 (59.4) | 75 (20.1) | < 0.001 | |
Reoperation | 3 (9.4) | 14 (3.7) | 0.286 | |
Acute rejection | 4 (12.5) | 63 (16.8) | 0.525 | |
Post-LT renal replacement therapy | 8 (25.0) | 11 (2.9) | < 0.001 | |
Glucocorticoidse ≥ 1500 mg | 19 (59.4) | 237 (63.4) | 0.653 | |
Basiliximab use ≥ 40 mg | 10 (31.3) | 149 (39.8) | 0.339 | |
Anti-thymocyte globulin use | 1 (3.1) | 17 (4.5) | 1.000 | |
Multivariate analysis | ||||
Female sex | 0.031 | 2.829 (1.098-7.288) | ||
Intraoperative RBC transfusion ≥ 12 U | 0.016 | 3.466 (1.259-9.543) | ||
Creatinine on day 3 after LT ≥ 2 mg/dL | < 0.001 | 9.724 (4.077-23.194) | ||
Post-LT infections due to CRKP | 0.008 | 5.330 (1.534-18.524) | ||
Post-LT mechanical ventilation | 0.001 | 4.118 (1.790-9.476) |
Table 7 Univariate and multivariate Logistic regression analysis of risk factors for intensive care unit stay after liver transplantation ≥ 7, n (%)
Variables | ICU stay after LT ≥ 7 d (150) | ICU stay after LT < 7 d (256) | P value | OR (95%CI) |
Total | ||||
Univariate analysis | ||||
Female sex | 34 (22.7) | 38 (14.8) | 0.046 | |
Recipient age ≥ 55 yr | 45 (30.0) | 56 (21.9) | 0.068 | |
Recipient BMI ≥ 25 | 38 (25.3) | 68 (26.6) | 0.785 | |
MELD score at LT ≥ 22 | 98 (65.3) | 131 (51.2) | 0.005 | |
Hospital stay prior to LT ≥ 7 d | 98 (65.3) | 141 (55.1) | 0.043 | |
Viral cirrhosis/necrosis/tumor | 112 (74.7) | 192 (75.0) | 0.940 | |
Alcoholic cirrhosis | 11 (7.3) | 20 (7.8) | 0.861 | |
Pre-LT diabetes | 17 (11.3) | 31 (12.1) | 0.815 | |
Pre-LT creatinine ≥ 2 mg/dL | 18 (12.0) | 11 (4.3) | 0.004 | |
Infection within 2 months prior to LT | 57 (38.0) | 103 (40.2) | 0.657 | |
Pre-LT WBC count ≥ 10 × 109/L | 27 (18.0) | 123 (48.0) | 0.129 | |
Pre-LT lymphocyte count ≤ 0.5 × 109/L | 34 (22.7) | 64 (25.0) | 0.596 | |
Pre-LT platelet count ≤ 50 × 109/L | 46 (30.7) | 89 (34.8) | 0.397 | |
Pre-LT albumin level < 30 g/L | 28 (18.7) | 123 (48.0) | 0.687 | |
Donor age ≥ 50 yr | 46 (30.7) | 88 (34.4) | 0.443 | |
Steatosis ≥ 30% | 16 (10.7) | 26 (10.2) | 0.871 | |
Cold ischemia time ≥ 360 min | 78 (52.0) | 136 (53.1) | 0.827 | |
Duration of surgery ≥ 450 min | 31 (20.7) | 40 (15.6) | 0.197 | |
Intraoperative bleeding ≥ 3000 ml | 102 (68.0) | 135 (52.7) | 0.003 | |
Intraoperative RBC transfusion ≥ 12 U | 92 (61.3) | 129 (50.4) | 0.033 | |
ALT on day 1 after LT ≥ 1500 U/L | 41 (27.3) | 39 (15.2) | 0.003 | |
Creatinine on day 3 after LT ≥ 2 mg/dL | 30 (20.0) | 31 (12.1) | 0.032 | |
Albumin level on day 1 after LT < 30 g/L | 12 (8.0) | 16 (6.3) | 0.502 | |
Post-LT infections due to Klebsiella pneumoniae | 18 (12.0) | 14 (5.5) | 0.018 | |
Post-LT infections due to CRKP | 15 (10.0) | 6 (2.3) | 0.001 | |
Post-LT mechanical ventilation | 59 (39.3) | 35 (13.7) | < 0.001 | |
Reoperation | 11 (7.3) | 6 (2.3) | 0.015 | |
Acute rejection | 28 (18.7) | 39 (15.2) | 0.369 | |
Post-LT renal replacement therapy | 14 (9.3) | 5 (2.0) | 0.001 | |
Glucocorticoidse ≥ 1500 mg | 102 (68.0) | 154 (60.2) | 0.114 | |
Basiliximab use ≥ 40 mg | 55 (36.7) | 104 (40.6) | 0.430 | |
Anti-thymocyte globulin use | 7 (4.7) | 11 (4.3) | 0.861 | |
Multivariate analysis | ||||
MELD score at LT ≥ 22 | 0.020 | 1.695 (1.086-2.645) | ||
Intraoperative bleeding ≥ 3000 ml | 0.012 | 1.790 (1.139-2.813) | ||
ALT on day 1 after LT ≥ 1500 U/L | 0.017 | 1.915 (1.123-3.265) | ||
Post-LT renal replacement therapy | 0.014 | 4.058 (1.327-12.409) | ||
Post-LT mechanical ventilation | < 0.001 | 3.402 (2.052-5.639) |
- Citation: Guo L, Peng P, Peng WT, Zhao J, Wan QQ. Klebsiella pneumoniae infections after liver transplantation: Drug resistance and distribution of pathogens, risk factors, and influence on outcomes. World J Hepatol 2024; 16(4): 612-624
- URL: https://www.wjgnet.com/1948-5182/full/v16/i4/612.htm
- DOI: https://dx.doi.org/10.4254/wjh.v16.i4.612