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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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.
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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.
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22.	申存毅, 王婧, 林婷, 等. 肝移植术后多重耐药菌感染分布特征及危险因素. 肝胆胰外科杂志, 2020, 32(6): 355-360.
23.	刘梦元, 方芳. 肝移植后多重耐药菌感染的相关危险因素. 中国组织工程研究, 2019, 23(7): 1109-1114.
24.	杨进, 惠娜, 王九萍, 等. 肝移植术后多重耐药菌感染危险因素的Meta分析. 中华现代护理杂志, 2024, 30(29): 3980-3986.
25.	谢秀华, 姜英俊, 解曼, 等. 肝移植后早期受者发生感染的危险因素及病原学分析. 中华器官移植杂志, 2017, 38(4): 200-205.
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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.
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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.
37.	Di Bella S, Giacobbe DR, Maraolo AE, et al. Resistance to ceftazidime/avibactam in infections and colonisations by KPC-producing Enterobacterales: a systematic review of observational clinical studies. J Glob Antimicrob Resist, 2021, 25: 268-281.
38.	O’Donnell JN, Putra V, Lodise TP. Treatment of patients with serious infections due to carbapenem-resistant Acinetobacter baumannii: How viable are the current options?. Pharmacotherapy, 2021, 41(9): 762-780.
39.	Abdul-Mutakabbir JC, Griffith NC, Shields RK, et al. Contemporary perspective on the treatment of Acinetobacter baumannii infections: Insights from the Society of Infectious Diseases Pharmacists. Infect Dis Ther, 2021, 10(4): 2177-2202.
40.	Perez F, Hujer AM, Hujer KM, et al. Global challenge of multidrug-resistant Acinetobacter baumannii. Antimicrob Agents Chemother, 2007, 51(10): 3471-3484.
41.	Tamma PD, Aitken SL, Bonomo RA, et al. Infectious Diseases Society of America Guidance on the treatment of AmpC β-lactamase-producing Enterobacterales, carbapenem-resistant Acinetobacter baumannii, and Stenotrophomonas maltophilia infections. Clin Infect Dis, 2022, 74(12): 2089-2114.
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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. 中华人民共和国卫生部. 多重耐药菌医院感染预防与控制技术指南(试行). 中国危重病急救医学, 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. 王东, 周顺, 王勇, 等. 肝移植术后多重耐药菌感染特点及危险因素分析. 中华肝胆外科杂志, 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, 黄文治, 乔甫. 肝移植患者术后耐碳青霉烯类革兰阴性菌感染的影响因素分析. 中华医院感染学杂志, 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. 谈宜斌, 金学兰, 李源, 等. 肝移植术后医院感染流行病学分析. 中华器官移植杂志, 2018, 39(10): 592-596.
21. 韩铎, 何宏, 王宏伟, 等. 肝移植术后感染病原菌分布及耐药性分析. 临床肝胆病杂志, 2023, 39(6): 1366-1373.
22. 申存毅, 王婧, 林婷, 等. 肝移植术后多重耐药菌感染分布特征及危险因素. 肝胆胰外科杂志, 2020, 32(6): 355-360.
23. 刘梦元, 方芳. 肝移植后多重耐药菌感染的相关危险因素. 中国组织工程研究, 2019, 23(7): 1109-1114.
24. 杨进, 惠娜, 王九萍, 等. 肝移植术后多重耐药菌感染危险因素的Meta分析. 中华现代护理杂志, 2024, 30(29): 3980-3986.
25. 谢秀华, 姜英俊, 解曼, 等. 肝移植后早期受者发生感染的危险因素及病原学分析. 中华器官移植杂志, 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, 贾哲, 等. 肝移植术后耐碳青霉烯肺炎克雷伯菌感染危险因素分析. 中华移植杂志(电子版), 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. 中华医学会器官移植学分会. 器官移植术后耐药菌感染诊疗技术规范(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. 中国医师协会器官移植医师分会, 中华医学会器官移植学分会. 中国实体器官移植手术部位感染管理专家共识(2022版). 器官移植, 2023, 14(1): 11-23,48.
33. 何红, 黄紫嫣, 陶晓燕, 等. 耐碳青霉烯类肺炎克雷伯菌产酶耐药机制及同源性分析. 中华医院感染学杂志, 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, 林东昉. 美国感染病学会对产超广谱β内酰胺酶肠杆菌目细菌、碳青霉烯类耐药肠杆菌目细菌和难治性耐药铜绿假单胞菌的治疗指导原则. 中国感染与化疗杂志, 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.
37. Di Bella S, Giacobbe DR, Maraolo AE, et al. Resistance to ceftazidime/avibactam in infections and colonisations by KPC-producing Enterobacterales: a systematic review of observational clinical studies. J Glob Antimicrob Resist, 2021, 25: 268-281.
38. O’Donnell JN, Putra V, Lodise TP. Treatment of patients with serious infections due to carbapenem-resistant Acinetobacter baumannii: How viable are the current options?. Pharmacotherapy, 2021, 41(9): 762-780.
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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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