Бактериальные осложнения после трансплантации печени. Перспективы дальнейших исследований

В данной статье представлен обзор современной литературы, посвященный бактериальным осложнениям раннего посттрансплантационного периода и перспективным направлениям изучения бактериальной флоры у пациентов после трансплантации печени. Учитывая сложность и «многогранность» проблемы, целью настоящего обзора литературы выступало обобщение сведений о сохраняющейся актуальности бактериальных осложнений, а также современных и перспективных направлениях их диагностики. В этой связи в работе описываются проблемы возникновения, распространения и патогенеза различных видов бактериальных осложнений, рассмотрены имеющиеся на сегодняшний день концепции влияния различных видов бактериальных осложнений на результаты трансплантации печени. Приведен обзор результатов исследований пациентов с развившейся в  посттрансплантационном периоде вентилятор-ассоциированной пневмонией. Представлен анализ гипотезы развития бактериальных осложнений с позиции микробиомного воздействия на билиарное дерево. Проведен анализ научных работ, основанных на сравнительно новом концептуальном подходе изучения результатов научных исследований с использованием методики машинного обучения. В качестве основных осложнений бактериального характера в данной статье была выбрана так называемая в номенклатуре CDC – «Большая Четверка». Однако катетер-ассоциированные бактериальные осложнения, патогенез развития которых на сегодняшний день является достаточно изученным, были заменены на сравнительно новую группу осложнений – бактериобилию.
В статье также приведены собственные краткие статистические данные, собранные в рамках исследования NCT04281797. Собственная когорта состояла из 57 пациентов, перенесших ортотопическую трансплантацию печени от посмертного донора. В нашем исследовании наиболее частным бактериальным осложнением раннего послеоперационного периода была инфекция области хирургического вмешательства. Наиболее частым возбудителем бактериальной инфекции выступала Klebsiella pneumoniae и Enterococcus spp.

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