Risk Factors for Multidrug-Resistant Bacterial Infections After Liver Transplantation

BACKGROUND Multidrug-resistant bacterial (MDRB) infections are a major complication after liver transplantation, contributing to increased morbidity, prolonged hospitalization, and reduced survival. Immunosuppression, invasive procedures, and prolonged intensive care stay are known to increase susceptibility to MDRB. However, specific clinical risk factors in post-transplant patients remain incompletely understood. This study aimed to identify risk factors for MDRB infections following liver transplantation. MATERIAL AND METHODS We retrospectively analyzed data on 350 patients who underwent liver transplantation at our hospital between January 2019 and March 2023. Patients were divided into a non-MDRB infection group (300 cases) and an MDRB infection group (50 cases). Clinical parameters were compared between groups. Multivariate logistic regression was used to identify independent risk factors for MDRB infection. RESULTS The 1-year survival rate was significantly lower in the MDRB group compared to the non-MDRB group (72.0% vs 87.7%, P<0.001). Univariate analysis identified 6 potential risk factors: tracheal intubation ≥48 h post-transplant, reoperation, tacrolimus (Tac) blood concentration, hospital stay ≥30 days, Child-Pugh classification, and intensive care unit stay ≥72 h (all P<0.05). Multivariate analysis showed that tracheal intubation ≥48 h (OR=2.714, 95% CI: 1.821-4.260, P=0.015), reoperation (OR=2.681, 95% CI: 2.015-5.402, P=0.001), and peak Tac blood concentration (OR=2.612, 95% CI: 1.405-4.710, P=0.007) were independent risk factors. CONCLUSIONS Prolonged tracheal intubation, reoperation, and elevated Tac blood concentration are key risk factors for MDRB infections after liver transplantation. Early identification and management of these factors may reduce MDRB incidence and improve patient outcomes.