摘要
目的 探讨肝移植术后早期（3个月之内）感染患者的危险因素、病原菌分布及耐药现状,为临床诊疗及预防提供参考.方法 收集2014年2月至2015年12月112例受者的临床资料,对肝移植受者术后早期发生感染的危险因素进行Logistic回归统计分析,最终筛选出影响肝移植术后感染的独立危险因素;同时对病原菌培养结果及药敏试验结果进行统计学描述.结果 肝移植术后3个月发生感染的独立危险因素为手术时长≥600min[P=0.003,优势比（OR）=9.996,95％可信区间（95％CI）为2.221～44.981]、重症监护（Intensive care unit,ICU）时长≥6天（P=0.010,OR=6.306,95％CI为1.563～25.437）、Child-Pugh分级为C级（P=0.023,OR=6.298,95％CI为1.294～30.659）;112例肝移植受者中,59例发生感染（感染发生率为52.68％）,共分离出168株病原菌.按标本感染的阳性率高低依次为痰、胆汁、腹水、引流物及导管末端、血液、深静脉导管、中段尿、胸水和经外周静脉穿刺中心静脉置管（Peripherally Inserted Central Catheter,PICC）.按菌种检出率高低依次为革兰阳性菌46.43％（78株）、革兰阴性菌29.76％（50株）,真菌18.45％（31株）,病毒5.36％（9株）.感染主要发生在术后1个月内,约占80.36％（135株）,尤以术后1周为高,约占34.52％（58株）.革兰阳性菌对青霉素类、大环内酯类、氨基糖苷类、喹诺酮类、林可酰胺类等均有较高耐药率,其中尤以屎肠球菌耐药率最高;革兰阴性菌则根据菌种不同呈现耐药的菌种个体化,对于碳青霉烯类耐药率相对较低.结论 感染是肝移植术后最常见的并发症之一,为降低肝移植术后感染发生率,应努力缩短手术时长,ICU留置时间,改善受者基础营养状态,加强肝移植术后受者感染的监测,进一步提高术后肝移植受者的存活率及生活质量.
Objective To explore the risk factors,the distribution of etiology and drug resistance status of patients with early infection （3 months） after liver transplantation,and to provide reference for clinical diagnosis and treatment.Methods The clinical data of 112 recipients from February 2014 to December 2015 were collected,and logistic regression analysis was performed on the risk factors of early postoperative infection in liver transplant patients.The independent risk factors of infection after liver transplantation were screened out.At the same time,the results of pathogen culture and drug sensitivity test were statistically described.Results The independent risk factors for infection at 3th month after liver transplantation included the operative time ≥600 min [P =0.003,odds ratio （OR） =9.996,95 % confidence interval （95 % CI）,2.221-44.981],intensive care unit （ICU） ≥6 days （P =0.010,OR =6.306,95% CI =1.563-25.437）,Child-Pugh grade of C （P =0.023,OR =6.298,95% CI =1.294-30.659）.Of the 112 liver transplant recipients,59 had an infection （52.68%）,and 168 stains of pathogens were isolated.The positive rate of the specimens was highest in sputum,followed by bile,ascites,drainage and catheter end,blood,deep vein catheter,middle urinary,pleural effusion and peripherally inserted central catheter （PICC）.The detectable rate of gram-negative bacteria,gram-positive bacteria,fungi and viruses was 46.43% （78 strains）,29.76% （50 strains）,18.45% （31 strains）,and 5.36% （9 strains） respectively.Infection occurred mainly within 1 month after surgery,accounting for about 80.36% （135 strains）,especially at 1st week after surgery,accounting for about 34.52% （58 strains）.Gram-positive bacteria had a higher drug resistance rate,including penicillins,macrolides,aminoglycosides,quinolones,linamides,etc.especially in the highest rate of Enterococcus faeciurr.Gram-negative bacteria were individualized based on the different strains of the bacteria,and they were relatively low in the resistance of the carbapene.Conclusion Infection is one of the most common complications after liver transplantation.To reduce the incidence of infection after liver transplantation,efforts should be made to shorten the duration of operation and ICU stay time,improve the basic nutritional status of recipients,and enhance monitoring of the recipient＇s infection after liver transplantation,to further increase the survival rate of postoperative liver transplantation recipients and improve the quality of life.
作者
谢秀华
姜英俊
解曼
孔心涓
饶伟
臧运金
王婷婷
Xie Xiuhua Jiang Yingjun Xie Man Kong Xinjuan Rao Wei Zang Yunjin Wang Tingting(The Affiliated Hospital of Qingdao University, Qingdao 266003, Chin)
出处
《中华器官移植杂志》
CAS
CSCD
2017年第4期200-205,共6页
Chinese Journal of Organ Transplantation
关键词
肝移植
感染
危险因素
病原菌分布
耐药分析
Liver transplantation
Infection
Risk factors
Pathogen distribution
Drug resistance analysis
