Epidemiological Shifts and Prognostic Risk Factors for Early Postoperative Gram-Negative Bacterial Infections in Liver Transplant Recipients: A 10-Year Retrospective Study

Objective

Gram-negative bacterial (GNB) infections, particularly multidrug-resistant GNB (MDR-GNB), significantly affect survival after liver transplantation. This study analyzed the epidemiology, resistance profiles, and mortality risk factors for early postoperative GNB infections.

Methods

We retrospectively reviewed 1,115 patients undergoing liver transplantation (2015–2024); 110 developed GNB infections within 30 days. Pathogen distribution, resistance patterns, and risk factors for MDR-GNB and mortality were analyzed using logistic regression.

Results

The MDR-GNB infection rate was 68.2% (75/110). Among 182 isolates, Klebsiella pneumoniae (33.0%) and Acinetobacter baumannii (30.2%) predominated. Common infection sites were abdominal cavity (44.5%) and respiratory tract (37.9%). Carbapenem resistance was high (87.5%); tigecycline (21.2%) and minocycline (49.0%) showed higher susceptibility. Pre-transplant MELD score ≥ 30 independently predicted MDR-GNB infection (OR = 4.094, P = 0.040). The 30-day mortality rate was 14.5% (16/110). Independent mortality risk factors included septic shock (OR = 387.098, P < 0.001), serum creatinine ≥ 133 µmol/L (OR = 7.136, P = 0.005), lymphocyte count ≤ 0.3×10⁹/L (OR = 4.719, P = 0.026), and MELD score ≥ 30 (OR = 3.971, P = 0.041). MDR-GNB infection correlated with lower 30-day survival (Log-rank P = 0.020).

Conclusion

Early postoperative GNB infections were predominantly MDR with severe carbapenem resistance. Septic shock, renal dysfunction, lymphocytopenia, and high MELD score independently increased mortality, highlighting the need for enhanced infection control, tailored empiric therapy, and early intervention.

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