Risk Factors for E2SKAPE Infections and Mortality Among Liver Transplant Recipients.

PURPOSE: Infections caused by Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp (ESKAPE) plus Escherichia coli (E2SKAPE), in particular multidrug-resistant (MDR) E2SKAPE infections, occur frequently and pose a life-threatening to liver transplant (LT) recipients. To prevent E2SKAPE infections and improve the prognosis of LT recipients, the identification of risk factors for E2SKAPE infections and mortality is necessary. METHODS: E2SKAPE pathogens were isolated and identified from clinical samples following standard microbiological procedures. All episodes of E2SKAPE infections and mortality documented among LT recipients were analyzed. FINDINGS: A total of 83 episodes of E2SKAPE infections, including 75 (90.4%) episodes of MDR-E2SKAPE infections, occurred in 23.1% (53/229) of LT recipients. E. faecium was the dominant causative bacterium (37/83; 44.6%). The most common site of infections was the urinary tract (14/53; 26.4%). Sixteen (7%) patients died within 2 months after LT, and 7 deaths were E2SKAPE infections-related. Multivariate logistic regression analysis revealed that female sex [odds ratio (OR) = 3.665, 95% confidence interval (CI): 1.614-8.321, P = 0.002], duration of surgery ≥ 400 min [OR = 2.328, 95%CI: 1.151-4.707, P = 0.019], intraoperative red blood cell (RBC) transfusion ≥ 12U [OR = 2.542, 95%CI: 1.218-5.306, P = 0.013] and indwelling urethral catheter use ≥ 3 days [OR = 3.96, 95%CI: 1.309-11.981, P = 0.015] were independent risk factors for E2SKAPE infections after LT, and that only exposure to more than 2 intravenous antibiotics post-LT [OR = 0.318, 95%CI: 0.15-0.674, P = 0.003] was negatively associated with acquisition of E2SKAPE infections. The predictors of crude mortality included female sex [OR = 4.822, 95%CI: 1.299-17.904, P = 0.019], creatinine on day 3 post-LT > 1.5 mg/dL [OR = 11.014, 95%CI: 2.985-40.637, P < 0.001], mechanical ventilation post-LT [OR = 10.724, 95%CI: 2.695-42.676, P = 0.001] and recipients with E2SKAPE infections [OR = 4.112, 95%CI: 1.169-14.47, P = 0.028]. IMPLICATIONS: A high incidence of E2SKAPE infections was noted in the early post-LT period. The most common infection site was the urinary tract, and the dominant pathogenic bacterium was E. faecium. Female sex, prolonged surgery time, massive RBC transfusion, or delayed urethral catheter removal were associated with E2SKAPE infections. Only exposure to more than 2 intravenous antibiotics post-LT was negatively related to the acquisition of E2SKAPE infections. The predictors of mortality included female sex, creatinine on day 3 post-LT>1.5 mg/dL, mechanical ventilation post-LT, and recipients with E2SKAPE infections.

Characteristics of Gram-positive cocci infection and the therapeutic effect after liver transplantation. / è‚ç§»æ¤æœ¯åŽé©å °æ°é˜³æ€§çƒèŒçš„æ„ŸæŸ“ç‰¹ç‚¹åŠé˜²æ²»æ•ˆæžœ.

OBJECTIVES: Gram-positive cocci is the main pathogen responsible for early infection after liver transplantation (LT), posing a huge threat to the prognosis of liver transplant recipients. This study aims to analyze the distribution and drug resistance of Gram-positive cocci, the risk factors for infections and efficacy of antibiotics within 2 months after LT, and to guide the prevention and treatment of these infections. METHODS: In this study, data of pathogenic bacteria distribution, drug resistance and therapeutic efficacy were collected from 39 Gram-positive cocci infections among 256 patients who received liver transplantation from donation after citizens' death in the Third Xiangya Hospital of Central South University from January 2019 to July 2022, and risk factors for Gram-positive cocci infection were analyzed. RESULTS: Enterococcus faecium was the dominant pathogenic bacteria (33/51, 64.7%), followed by Enterococcus faecalis (11/51, 21.6%). The most common sites of infection were abdominal cavity/biliary tract (13/256, 5.1%) and urinary tract (10/256, 3.9%). Fifty (98%) of the 51 Gram-positive cocci infections occurred within 1 month after LT. The most sensitive drugs to Gram-positive cocci were teicoplanin, tigecycline, linezolid and vancomycin. Vancomycin was not used in all patients, considering its nephrotoxicity. Vancomycin was not administered to all patients in view of its nephrotoxicity.There was no significant difference between the efficacy of daptomycin and teicoplanin in the prevention of cocci infection (P>0.05). Univariate analysis indicated that preoperative Model for End-Stage Liver Disease (MELD) score >25 (P=0.005), intraoperative red blood cell infusion ≥12 U (P=0.013) and exposure to more than 2 intravenous antibiotics post-LT (P=0.003) were related to Gram-positive cocci infections. Multivariate logistic regression analysis revealed that preoperative MELD score >25 (OR=2.378, 95% CI 1.124 to 5.032, P=0.024) and intraoperative red blood cell transfusion ≥ 12 U (OR=2.757, 95% CI 1.227 to 6.195, P=0.014) were independent risk factors for Gram-positive cocci infections after LT. Postoperative Gram-positive cocci infections were reduced in LT recipients exposing to more than two intravenous antibiotics post-LT (OR=0.269, 95% CI 0.121 to 0.598, P=0.001). CONCLUSIONS: Gram-positive cocci infections occurring early after liver transplantation were dominated by Enterococcus faecalis infections at the abdominal/biliary tract and urinary tract. Teicoplanin, tigecycline and linezolid were anti-cocci sensitive drugs. Daptomycin and teicoplanin were equally effective in preventing cocci infections due to Gram-positive cocci. Patients with high preoperative MELD score and massive intraoperative red blood cell transfusion were more likely to suffer Gram-positive cocci infection after surgery. Postoperative Gram-positive cocci infections were reduced in recipients exposing to more than two intravenous antibiotics post-LT.

Mitigating the Surface Reconstruction of Ni-Rich Cathode via P2-Type Mn-Rich Oxide Coating for Durable Lithium Ion Batteries.

Ni-rich materials have received widespread attention as one of the mainstream cathodes in high-energy-density lithium-ion batteries for electric vehicles. However, Ni-rich cathodes suffer from severe surface reconstruction in a high delithiation state, constraining their rate capabilities and life span. Herein, a novel P2-type NaxNi0.33Mn0.67O2 (NNMO) is rationally selected as the surficial modification layer for LiNi0.8Co0.1Mn0.1O2 (NCM811) cathode, which undergoes a spontaneous Na+-Li+ exchange reaction to form an O2-type LixNi0.33Mn0.67O2 (LNMO) layer revealed by combining X-ray diffraction and solid-state nuclear magnetic resonance techniques. Owing to the specific oxygen stacking sequence, O2-type LNMO significantly prevents the initial layered structure of NCM811 from transforming to the spinel or rock-salt phases during cycling, thus effectively maintaining the integral surficial structure and the Li+ diffusion channels of NCM811. Eventually, the NNMO@NCM811 electrode yields enhanced thermal stability, outstanding rate performance, and long cycling stability with 80% capacity retention after 294 cycles at 200 mA g-1, and its life span is further extended to 531 cycles while enhancing the mechanical stability of the bulk material.

Constructing a High-Energy and Durable Single-Crystal NCM811 Cathode for All-Solid-State Batteries by a Surface Engineering Strategy.

Single-crystal LiNi0.8Co0.1Mn0.1O2 (S-NCM811) with an electrochemomechanically compliant microstructure has attracted great attention in all-solid-state batteries (ASSBs) for its superior electrochemical performance compared to the polycrystalline counterpart. However, the undesired side reactions on the cathode/solid-state electrolyte (SSE) interface causes inferior capacity and rate capability than lithium-ion batteries, limiting the practical application of S-NCM811 in the ASSB technology. Herein, it shows that S-NCM811 delivers a high capacity (205 mAh g-1, 0.1C) with outstanding rate capability (175 mAh g-1 at 0.3C and 116 mAh g-1 at 1C) in ASSBs by the coating of a nano-lithium niobium oxide (LNO) layer via the atomic layer deposition technique combined with optimized post-annealing treatment. The working mechanism is verified as the nano-LNO layer effectively suppresses the decomposition of sulfide SSE and stabilizes the cathode/SSE interface. The post-annealing of the LNO layer at 400 °C improves the coating uniformity, eliminates the residual lithium salts, and leads to small impedance increasing and less electrochemical polarization during cycling compared with pristine materials. This work highlights the critical role of the post-annealed nano-LNO layer in the applications of a high-nickel cathode and offers some new insights into the designing of high-performance cathode materials for ASSBs.