To investigate the risk factors of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection after liver transplantation.

The clinical data of 186 patients who underwent liver transplantation in the Liver Transplantation Center of Beijing You′an Hospital from January 2018 to January 2020 were retrospectively analyzed. The patients were divided into non-infected group (n=63), non-CRKP-infected group (n=102) and CRKP-infected group (n=21). The preoperative indexes such as age, gender, modle for end-stage liver disease (MELD) score and Child-Pugh grade, the intraoperative indexes such as operation time, anhepatic period, blood loss and blood transfusion, the time of endotracheal intubation and ICU stay, the incidence of complications and continuous renal replacement therapy (CRRT) were observed. Abnormal distribution data were compared by Kruskal-Wallis test, and Dunn test was used for inter-group comparison. The counting data were compared by Chi-square test and Bonferroni correction. The risk factors of CRKP infection in perioperative period were analyzed by multiple logistic regression. A P<0.05 was considered statistically significant.

There were significant differences in preoperative MELD score, Child-Pugh grade, primary liver cancer, liver failure, preoperative infection, use of carbapenem antibiotics for more than 7 days in one month before operation and the proportion of preoperative endotracheal intubation among non-infected group, non-CRKP-infected group and CRKP-infected group (χ²= 9.03, 22.67, 3.80, 3.15, 13.67, 8.52 and 7.29, all P<0.05). There were significant differences in intraoperative blood loss and transfusion among three groups (χ²=15.60, 23.08, all P<0.05). As of April 1, 2020, all subjects had been followed up for more than 3 months. There was no death in the non-infected group; 17 and 14 patients in non-CRKP-infected group and CRKP-infected group died respectively (all died during hospitalization). The mortality rates were 17% and 67%, respectively (χ²= 23.09, P<0.05). There were significant differences in intubation time, ICU stay, complications, CRRT, early liver dysfunction and the proportion of co-infection among the three groups (χ²= 22.92, 14.46, 30.34, 21.91, 5.74 and 77.21, all P<0.05). Compared with the non-infected group, the risk factors of CRKP infection were recipient gender, MELD score, use of carbapenem antibiotics for more than 7 days in one month before operation, preoperative infection and preoperative diagnosis of liver failure and liver cancer (OR= 0.25, 1.09, 7.14, 7.17, 8.70 and 0.22, all P<0.05).

Recipient gender, MELD score, carbapenem antibiotics used for more than 7 days within one month before operation, preoperative infection and preoperative diagnosis of liver failure and liver cancer are high risk factors for CRKP infection after liver transplantation, which has important clinical significance for guiding rational use of antibiotics before operation, reducing the risk of infection caused by drug-resistant bacteria and accurate and targeted anti-infection treatment after operation.