Canlı Donörden Karaciğer Transplantasyonu Yapılan Hastaların Safra Yolu Mikroorganizma Profili ve Antibiyotik Duyarlılıkları

Abstract

Yıldırım A, Biliary Tract Microorganism Profile and Antibiotic Susceptibility of Patients with Liver Transplantation from a Living Donor, Hacettepe University Faculty of Medicine, Thesis in Internal Medicine, Ankara 2020 Living donor liver transplant (LDLT) patients constitute a special group of patients because they have the biliary hilar stricture and are immunosuppressed with the drugs they use. The study aims is to determine the microorganism profile to be obtained from bile and blood cultures and the resistance profile of microorganisms in the case of bacteremia and cholangitis developing after endoscopic or percutaneous intervention in a LDLT patient group. A total of 24 patients with cholangitis or bacteremia [9 (37.5%) women, median age 56 (32-69)] were inclueded in the study by screening LDLT patients who underwent Endoscopic Retrograde Cholangiopancreatography (ERCP) and / or Percutaneous Transhepatic Biliary Drainage (PTBD) at Hacettepe University Faculty of Medicine Adult Hospital between January 1, 2017 and June 31, 2020. As the control group, patients who underwent ERCP and / or PTBD were screened and a total of 70 patients [36 (51.4%) women, median age 63 (22-95)] with cholangitis or bacteremia were included. Polymicrobial growth in bile culture (65.2%) in patients with LDLT was higher than the control group (38.2%). Monomicrobial growth was higher in the control group (33.3% x 61.8% in blood culture and 17.4% x 44.1% in bile culture). Gram negative microorganism predominance was detected in the growths in both groups. Frequency of Pseudomonas aeruginosa growth in bile cultures (45.5% x 23.5% and p = 0.086) in patients with LDLT and the frequency of growth of Escherichia coli in any culture in the control group (68% x 30.4% and p = 0.003) higher detected. Gram positive microorganisms grown in any culture were examined, the tendency of Enteroccocus faecium to grow more frequently in LDLT patients was observed (47.8% x 26.5% and p = 0.097). It was observed that antibiotic resistance was higher in gram positive microorganisms in patients with LDLT. Multidrug resistance (MDR) (75% x 22.2% and 53.3% x 21.4% in blood and bile cultures, respectively) and extended drug resistance (XDR) (75% x 11.1% in blood and bile cultures, respectively and 53.3% x 7.1%). MDR gram positive microorganisms were examined, it was seen that the most common growth was E.faecium. MDR E.faecium growth was detected in 39.1% (9/23) in the LDLT group and 6.3% (2/32) in the control group. Gram-negative microorganisms were examined, MDR and XDR were seen at high rates in both groups. MDR in LDLT and control groups (100% x 86% and 77.3% x 79.4% in blood and bile cultures, respectively] and XDR [100% x 69.8% and 77.3 x 70.% in blood and bile cultures, respectively] were detected. MDR gram negative microorganisms were examined, it was observed that E. Coli was more common in the control group. MDR E. Coli growth was detected in 30.4% (7/23) in the LDLT group and 57.8% (26/45) in the control group. Antibiotic susceptibilities were examined, the ampicillin sensitivity of E.faecium grown in bile culture in the LDLT group was found to be 11.1% (1/9). No glycopeptide resistance was detected in the LDLT group. When Gram-negative microorganisms were evaluated, carbapenem and amikacin sensitivity of P.aeruginosa grown in bile culture in LDLT patients was found to be 28.6% (2/7) and 85.7% (6/7), respectively. Empirical treatment of cholangitis developing in patients with LDLT, it is considered appropriate to initiate regimens including glycopeptide group antibiotic therapy, considering the epidemiological data of the centers.