{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T21:18:31Z","timestamp":1776719911204,"version":"3.51.2"},"reference-count":70,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T00:00:00Z","timestamp":1744588800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Objective: Accurate risk stratification at an early stage may reduce the incidence of infection and improve the survival rate of recipients by adopting targeted interventions. This study aimed to develop a nomogram to predict the risk of multidrug-resistant organism (MDRO) infections in liver transplant (LT) recipients. Methods: We retrospectively collected clinical data from 301 LT recipients and randomly divided them into a training set (210 cases) and validation set (91 cases) using a 7:3 split ratio. Factors related to the risk of MDRO infection after LT were determined using univariate and multivariate bidirectional stepwise logistic regression. The model\u2019s predictive performance and discrimination ability were evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Results: 56 (18.60%) patients developed a MDRO infection, including 37 (17.62%) in the training cohort and 19 (20.88%) in the validation cohort. Ultimately, five factors related to MDRO infection after LT surgery were established: ascites (OR = 3.48, 95% CI [1.33\u20139.14], p = 0.011), total bilirubin (OR = 1.01, 95% CI [1.01\u20131.01], p &lt; 0.001), albumin (OR = 0.85, 95% CI [0.75\u20130.96], p = 0.010), history of preoperative ICU stay (OR = 1.09, 95% CI [1.01\u20131.17], p = 0.009), and length of ICU stay (OR = 3.70, 95% CI [1.39\u20139.84], p = 0.019). The model demonstrated strong discrimination, and the area under the curve (AUC), sensitivity, and specificity of the training set were 0.88 (95% CI [0.81\u20130.94]), 0.82 (95% CI [0.76\u20130.87]), and 0.86 (95% CI [0.75\u20130.98]), respectively, while for the validation set, they were 0.77 (95% CI [0.65\u20130.90]), 0.76 (95% CI [0.67\u20130.86]), and 0.68 (95% CI [0.48\u20130.89]). The mean absolute error (MAE) in the validation cohort was 0.029, indicating a high accuracy. DCA showed a clinical benefit within a threshold probability range of 0.1 to 0.7. Conclusions: This study developed a clinically accessible nomogram to predict the risk of MDRO infection in LT recipients, enabling early risk stratification and the real-time assessment of infection risk based on the length of postoperative ICU stay. The model incorporates five easily obtainable clinical parameters (ascites, total bilirubin, albumin, preoperative ICU stay history, and length of ICU stay) and demonstrates strong predictive performance, facilitating the early identification of high-risk patients. Future research should focus on refining the model by incorporating additional clinical factors (e.g., immunosuppressive therapy adherence) and validating its generalizability in multicenter, large-sample cohorts to enhance its clinical utility.<\/jats:p>","DOI":"10.3390\/bioengineering12040417","type":"journal-article","created":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T06:18:36Z","timestamp":1744611516000},"page":"417","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Epidemiology and Risk Prediction Model of Multidrug-Resistant Organism Infections After Liver Transplant Recipients: A Single-Center Cohort Study"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-3941-9929","authenticated-orcid":false,"given":"Chuanlin","family":"Chen","sequence":"first","affiliation":[{"name":"School of Clinical Medicine, Qinghai University, Xining 810000, China"},{"name":"Department of Liver ICU, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing 100000, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Desheng","family":"Li","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine, Qinghai University, Xining 810000, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2114-5512","authenticated-orcid":false,"given":"Zhengdon","family":"Zhou","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine, Qinghai University, Xining 810000, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qinghua","family":"Guan","sequence":"additional","affiliation":[{"name":"Department of Liver ICU, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing 100000, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bo","family":"Sheng","sequence":"additional","affiliation":[{"name":"Department of Liver ICU, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing 100000, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9336-7796","authenticated-orcid":false,"given":"Yongfang","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing 100000, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhenyu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Liver ICU, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing 100000, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1111\/tri.12984","article-title":"Changing trends in the aetiology, treatment and outcomes of bloodstream infection occurring in the first year after solid organ transplantation: A single-centre prospective cohort study","volume":"30","author":"Oriol","year":"2017","journal-title":"Transplant. Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2107","DOI":"10.1097\/TP.0000000000001356","article-title":"Surgical Site Infections After Liver Transplantation: Emergence of Multidrug-Resistant Bacteria and Implications for Prophylaxis and Treatment Strategies","volume":"100","author":"Viehman","year":"2016","journal-title":"Transplantation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1111\/ajt.12096","article-title":"Multidrug-resistant gram-negative bacteria infections in solid organ transplantation","volume":"13","year":"2013","journal-title":"Am. J. Transplant."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1093\/clinids\/21.5.1077","article-title":"Infections in liver transplant recipients","volume":"21","author":"Winston","year":"1995","journal-title":"Clin. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1016\/j.jhep.2024.02.023","article-title":"Multidrug-resistant bacterial infections after liver transplantation: Prevalence, impact, and risk factors","volume":"80","author":"Aceituno","year":"2024","journal-title":"J. Hepatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"ofad247","DOI":"10.1093\/ofid\/ofad247","article-title":"Bacteremia During the First Year After Solid Organ Transplantation: An Epidemiological Update","volume":"10","author":"Neofytos","year":"2023","journal-title":"Open Forum Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1053\/jlts.2001.20769","article-title":"Evolving trends in multiple-antibiotic-resistant bacteria in liver transplant recipients: A longitudinal study of antimicrobial susceptibility patterns","volume":"7","author":"Singh","year":"2001","journal-title":"Liver Transplant."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Lanini, S., Costa, A.N., Puro, V., Procaccio, F., Grossi, P.A., Vespasiano, F., Ricci, A., Vesconi, S., Ison, M.G., and Carmeli, Y. (2015). Incidence of carbapenem-resistant gram negatives in Italian transplant recipients: A nationwide surveillance study. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0123706"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1002\/lt.24389","article-title":"Carbapenem-resistant Acinetobacter baumannii acquired before liver transplantation: Impact on recipient outcomes","volume":"22","author":"Freire","year":"2016","journal-title":"Liver Transplant."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1002\/lt.24327","article-title":"Risk factors and outcomes of carbapenem-resistant Klebsiella pneumoniae infections in liver transplant recipients","volume":"22","author":"Coskun","year":"2016","journal-title":"Liver Transplant."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2390072","DOI":"10.1080\/20523211.2024.2390072","article-title":"Clinical characteristics and risk factor analysis of recipients with multidrug-resistant bacterial bloodstream infections after liver transplantation: A single-centre retrospective study","volume":"17","author":"Chen","year":"2024","journal-title":"J. Pharm. Policy Pract."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e921591","DOI":"10.12659\/AOT.921591","article-title":"Bacterial and Fungal Infections After Liver Transplantation: Microbial Epidemiology, Risk Factors for Infection and Death with Infection","volume":"25","author":"Zhang","year":"2020","journal-title":"Ann. Transplant."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e14239","DOI":"10.1111\/ctr.14239","article-title":"Impact of pre-transplant carbapenem-resistant Enterobacterales colonization and\/or infection on solid organ transplant outcomes","volume":"35","author":"Taimur","year":"2021","journal-title":"Clin. Transplant."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3216","DOI":"10.1016\/j.transproceed.2014.09.159","article-title":"Bloodstream infections caused by carbapenemase-producing Klebsiella pneumoniae among intensive care unit patients after orthotopic liver transplantation: Risk factors for infection and impact of resistance on outcomes","volume":"46","author":"Mouloudi","year":"2014","journal-title":"Transplant. Proc."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Rasmussen, D.B., M\u00f8ller, D.L., Knudsen, A.D., Rostved, A.A., Knudsen, J.D., Rasmussen, A., and Nielsen, S.D. (2021). Enterococcal Infections the First Year after Liver Transplantation-A Prospective Cohort Study. Microorganisms, 9.","DOI":"10.3390\/microorganisms9081740"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/j.hbpd.2020.06.001","article-title":"Infection within 2 weeks before liver transplantation closely related to prognosis of posttransplant infection: A single-center retrospective observational study in China","volume":"19","author":"Ying","year":"2020","journal-title":"Hepatobiliary Pancreat. Dis. Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1016\/j.nut.2012.02.007","article-title":"Pre- and perioperative factors affecting infection after living donor liver transplantation","volume":"28","author":"Kaido","year":"2012","journal-title":"Nutrition"},{"key":"ref_18","first-page":"547","article-title":"Early-Onset Pneumonia After Liver Transplant: Microbial Causes, Risk Factors, and Outcomes, Mansoura University, Egypt, Experience","volume":"15","author":"Ali","year":"2017","journal-title":"Exp. Clin. Transplant."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Dolci, G., Burastero, G.J., Paglia, F., Cervo, A., Meschiari, M., Guaraldi, G., Chester, J., Mussini, C., and Franceschini, E. (2023). Epidemiology and Prevention of Early Infections by Multi-Drug-Resistant Organisms in Adults Undergoing Liver Transplant: A Narrative Review. Microorganisms, 11.","DOI":"10.3390\/microorganisms11061606"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1093\/cid\/cis519","article-title":"Transmission of infection with human allografts: Essential considerations in donor screening","volume":"55","author":"Fishman","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1016\/j.idc.2018.04.004","article-title":"Multidrug-Resistant Bacterial Infections in Solid Organ Transplant Candidates and Recipients","volume":"32","author":"Bartoletti","year":"2018","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_22","first-page":"216","article-title":"Analysis and Prediction of Risk Factors for Early Infection After Liver Transplantation","volume":"16","author":"Mi","year":"2022","journal-title":"Chin. J. Transplant."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.6002\/ect.2021.0431","article-title":"Nomogram Prediction for Postoperative Mortality of Orthotopic Liver Transplantation","volume":"20","author":"Liu","year":"2022","journal-title":"Exp. Clin. Transplant."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e955","DOI":"10.1093\/cid\/ciab109","article-title":"Development of a Risk Prediction Model for Carbapenem-resistant Enterobacteriaceae Infection After Liver Transplantation: A Multinational Cohort Study","volume":"73","author":"Giannella","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Shen, G., Zhang, L., Fan, W., Lv, H., Wang, F., Ye, Q., Lin, M., Yu, X., Cai, H., and Wu, X. (2023). Establishment of a risk prediction model for multidrug-resistant bacteria in deceased organ donors: A retrospective cohort study in China. Front. Cell Infect. Microbiol., 13.","DOI":"10.3389\/fcimb.2023.1181630"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1588","DOI":"10.1080\/0886022X.2021.2009863","article-title":"Development and validation of a nomogram for predicting acute kidney injury after orthotopic liver transplantation","volume":"43","author":"Guo","year":"2021","journal-title":"Ren. Fail."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Chen, W., Wu, S., Gong, L., Guo, Y., Wei, L., Jin, H., Zhou, Y., Li, C., Lu, C., and Xu, L. (2023). Exploring the risk factors of early sepsis after liver transplantation: Development of a novel predictive model. Front. Med., 10.","DOI":"10.3389\/fmed.2023.1274961"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/j.1469-0691.2011.03570.x","article-title":"Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance","volume":"18","author":"Magiorakos","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_29","first-page":"1","article-title":"Chinese Guidelines for the Diagnosis and Treatment of Intra-abdominal Infections (2019 Edition)","volume":"40","author":"Wu","year":"2020","journal-title":"Chin. J. Pract. Surg."},{"key":"ref_30","first-page":"343","article-title":"Standardized Diagnostic and Therapeutic Techniques for Postoperative Infections in Solid Organ Transplantation (2019 Edition)\u2014General Discussion and Bacterial Pneumonia","volume":"10","author":"Li","year":"2019","journal-title":"Organ. Transplant."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e159","DOI":"10.1093\/cid\/ciz1113","article-title":"Burden and Timeline of Infectious Diseases in the First Year After Solid Organ Transplantation in the Swiss Transplant Cohort Study","volume":"71","author":"Stampf","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1016\/j.surg.2018.04.039","article-title":"Early mortality after liver transplantation: Defining the course and the cause","volume":"164","author":"Baganate","year":"2018","journal-title":"Surgery"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"236","DOI":"10.6002\/ect.2022.0412","article-title":"Impact of Prophylactic Norfloxacin in Multidrug Resistant Bacterial Infections in the Early Liver Posttransplant Period","volume":"21","author":"Oriol","year":"2023","journal-title":"Exp. Clin. Transplant."},{"key":"ref_34","first-page":"952","article-title":"Multidrug-Resistant Infections After Liver Transplantation, Etiology and Risk Factors: A Single-Center Experience","volume":"21","author":"Tezcan","year":"2023","journal-title":"Exp. Clin. Transplant."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Taddei, R., Riccardi, N., Tiseo, G., Galfo, V., and Biancofiore, G. (2023). Early Intra-Abdominal Bacterial Infections after Orthotopic Liver Transplantation: A Narrative Review for Clinicians. Antibiotics, 12.","DOI":"10.3390\/antibiotics12081316"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1086\/422644","article-title":"Infected bilomas in liver transplant recipients: Clinical features, optimal management, and risk factors for mortality","volume":"39","author":"Safdar","year":"2004","journal-title":"Clin. Infect. Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1706","DOI":"10.1097\/TP.0b013e3181a60338","article-title":"Early intra-abdominal infections associated with orthotopic liver transplantation","volume":"87","author":"Reid","year":"2009","journal-title":"Transplantation"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"4983","DOI":"10.2147\/IDR.S332196","article-title":"The Distribution and Source of MRDOs Infection: A Retrospective Study in 8 ICUs, 2013\u20132019","volume":"14","author":"Li","year":"2021","journal-title":"Infect. Drug Resist."},{"key":"ref_39","first-page":"1282","article-title":"Targeted surveillance analysis of nosocomial infections in the intensive care unit over the past 13 years","volume":"22","author":"Jiang","year":"2023","journal-title":"Chin. J. Infect. Control"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Smithson, A., Ramos, J., Ni\u00f1o, E., Culla, A., Pertierra, U., Friscia, M., and Bastida, M.T. (2019). Characteristics of febrile urinary tract infections in older male adults. BMC Geriatr., 19.","DOI":"10.1186\/s12877-019-1360-3"},{"key":"ref_41","first-page":"1","article-title":"Multicenter expert consensus on the diagnosis and treatment of multidrug-resistant bacterial infections after liver transplantation","volume":"32","author":"Wang","year":"2025","journal-title":"Chin. J. General Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1111\/j.1399-3062.2009.00421.x","article-title":"Multidrug resistant gram-negative bacilli as predominant bacteremic pathogens in liver transplant recipients","volume":"11","author":"Shi","year":"2009","journal-title":"Transplant. Infect. Dis."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Barchiesi, F., Montalti, R., Castelli, P., Nicolini, D., Staffolani, S., Mocchegiani, F., Fiorentini, A., Manso, E., and Vivarelli, M. (2016). Carbapenem-Resistant Klebsiella pneumoniae influences the outcome of early infections in liver transplant recipients. BMC Infect. Dis., 16.","DOI":"10.1186\/s12879-016-1876-5"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"12469","DOI":"10.3389\/ti.2024.12469","article-title":"Burden and Management of Multi-Drug Resistant Organism Infections in Solid Organ Transplant Recipients Across the World: A Narrative Review","volume":"37","author":"Freire","year":"2024","journal-title":"Transplant. Int."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1097\/TP.0b013e3182a049fd","article-title":"Risk factors and outcomes of bacteremia caused by drug-resistant ESKAPE pathogens in solid-organ transplant recipients","volume":"96","author":"Bodro","year":"2013","journal-title":"Transplantation"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"dlae152","DOI":"10.1093\/jacamr\/dlae152","article-title":"Multidrug-resistant organism bloodstream infections in solid organ transplant recipients and impact on mortality: A systematic review","volume":"6","author":"Liu","year":"2024","journal-title":"JAC Antimicrob. Resist."},{"key":"ref_47","first-page":"1847","article-title":"Diagnostic and Therapeutic Guidelines for Cirrhotic Ascites and Related Complications","volume":"33","author":"Xu","year":"2017","journal-title":"J. Clin. Hepatol. Gastroenterol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1016\/j.cgh.2006.08.007","article-title":"Natural history of patients hospitalized for management of cirrhotic ascites","volume":"4","author":"Planas","year":"2006","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"112","DOI":"10.3349\/ymj.2009.50.1.112","article-title":"Epidemiology and risk factors for bacteremia in 144 consecutive living-donor liver transplant recipients","volume":"50","author":"Kim","year":"2009","journal-title":"Yonsei Med. J."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1002\/lt.20721","article-title":"MELD and prediction of post-liver transplantation survival","volume":"12","author":"Habib","year":"2006","journal-title":"Liver Transplant."},{"key":"ref_51","first-page":"489","article-title":"The predictive value of the first postoperative MELD score and its derived scores on early survival rate after liver transplantation in patients with liver failure","volume":"13","author":"Lai","year":"2022","journal-title":"Organ. Transplant."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Ferstl, P.G., Filmann, N., Heilgenthal, E.M., Schnitzbauer, A.A., Bechstein, W.O., Kempf, V.A.J., Villinger, D., Schultze, T.G., Hogardt, M., and Stephan, C. (2021). Colonization with multidrug-resistant organisms is associated with in increased mortality in liver transplant candidates. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0245091"},{"key":"ref_53","first-page":"739","article-title":"New strategies and technologies beyond the MELD score applied in liver transplantation","volume":"27","author":"Li","year":"2022","journal-title":"Liver"},{"key":"ref_54","first-page":"21","article-title":"Clinical Analysis of Perioperative Human Serum Albumin Application in Liver Transplant Patients","volume":"18","author":"Ai","year":"2020","journal-title":"Clin. Pharmacol. Ther. J."},{"key":"ref_55","first-page":"54","article-title":"Predicting bacteremia and bacteremic mortality in liver transplant recipients","volume":"6","author":"Singh","year":"2000","journal-title":"Liver Transplant."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1016\/j.jmii.2024.06.002","article-title":"Risk factors and crucial prognostic indicators of mortality in liver transplant recipients with bloodstream infections: A comprehensives study of 1049 consecutive liver transplants over an 11-year period","volume":"57","author":"Lee","year":"2024","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1111\/ctr.12486","article-title":"Impact of human albumin infusion on organ function in orthotopic liver transplantation\u2014A retrospective matched-pair analysis","volume":"29","author":"Ertmer","year":"2015","journal-title":"Clin. Transplant."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1007\/s11901-020-00521-1","article-title":"Hemodynamic and Systemic Effects of Albumin in Patients with Advanced Liver Disease","volume":"19","author":"Tufoni","year":"2020","journal-title":"Curr. Hepatol. Rep."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"24","DOI":"10.3892\/mmr.2023.13147","article-title":"Albumin, an interesting and functionally diverse protein, varies from \u2018native\u2019 to \u2018effective\u2019 (Review)","volume":"29","author":"Wu","year":"2024","journal-title":"Mol. Med. Rep."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1080\/17512433.2018.1412827","article-title":"Non-oncotic properties of albumin. A multidisciplinary vision about the implications for critically ill patients","volume":"11","author":"Ferrer","year":"2018","journal-title":"Expert. Rev. Clin. Pharmacol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1111\/j.1399-3062.2009.00380.x","article-title":"Pseudomonas aeruginosa bacteremia over a 10-year period: Multidrug resistance and outcomes in transplant recipients","volume":"11","author":"Johnson","year":"2009","journal-title":"Transplant. Infect. Dis."},{"key":"ref_62","first-page":"667","article-title":"Analysis of the colonization status and risk factors of multidrug-resistant bacteria in the intensive care unit","volume":"8","author":"Huang","year":"2015","journal-title":"Chin. J. Crit. Care Med."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.jinf.2011.12.005","article-title":"Multidrug-resistant gram-negative bacterial infections after liver transplantation\u2014Spectrum and risk factors","volume":"64","author":"Zhong","year":"2012","journal-title":"J. Infect."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"e14956","DOI":"10.1111\/ctr.14956","article-title":"Incidence, mortality, and risk factors associated with carbapenem-resistant Acinetobacter baumannii bacteremia within 30 days after liver transplantation","volume":"37","author":"Min","year":"2023","journal-title":"Clin. Transplant."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"3439","DOI":"10.2147\/IDR.S470883","article-title":"A Nomogram for Predicting the Effectiveness of Consultations on Multi-Drug Resistant Infections: An Exploration for Clinical Pharmacy Services","volume":"17","author":"Ao","year":"2024","journal-title":"Infect. Drug Resist."},{"key":"ref_66","first-page":"584","article-title":"Construction and Validation of a Nomogram Model for the Risk of Postoperative Multidrug-Resistant Bacterial Infections in Patients with Bone Trauma","volume":"21","author":"Guo","year":"2022","journal-title":"Chin. J. Infect. Control."},{"key":"ref_67","first-page":"384","article-title":"Research Progress on Predictive Models for Multidrug-Resistant Bacteria Infection Risk in Intensive Care Units","volume":"16","author":"He","year":"2023","journal-title":"Chin. J. Clin. Infect. Dis."},{"key":"ref_68","first-page":"52","article-title":"Interpretation and Enlightenment of the External Validation Guide for Clinical Risk Prediction Models (2024 Edition)","volume":"39","author":"Zhou","year":"2024","journal-title":"J. Nurs. Sci."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"e13086","DOI":"10.1111\/petr.13086","article-title":"A systematic review of immunosuppressant adherence interventions in transplant recipients: Decoding the streetlight effect","volume":"22","author":"Duncan","year":"2018","journal-title":"Pediatr Transplant."},{"key":"ref_70","first-page":"Cd012854","article-title":"Interventions for increasing immunosuppressant medication adherence in solid organ transplant recipients","volume":"9","author":"Mellon","year":"2022","journal-title":"Cochrane Database Syst. Rev."}],"container-title":["Bioengineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-5354\/12\/4\/417\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:14:00Z","timestamp":1760030040000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-5354\/12\/4\/417"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,14]]},"references-count":70,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["bioengineering12040417"],"URL":"https:\/\/doi.org\/10.3390\/bioengineering12040417","relation":{},"ISSN":["2306-5354"],"issn-type":[{"value":"2306-5354","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,14]]}}}