摘要
目的分析中山大学第一附属医院2016—2018年间肾移植术后细菌耐药性的具体情况,为肾移植术后细菌感染的经验性用药选择提供参考。方法回顾性分析中山大学第一附属医院2016—2018年期间肾移植科行肾移植手术后住院期间367例疑似感染患者的细菌耐药情况,主要包括患者细菌病原学的分布以及耐药性的变迁情况。结果肾移植术后患者共分离出400株细菌,其中革兰氏阴性菌226株(56.50%)、革兰氏阳性菌174株(43.50%)。排名前4位的革兰氏阴性菌分别是大肠埃希菌61株(15.25%)、肺炎克雷伯菌51株(12.75%)、铜绿假单胞菌31株(7.75%)、鲍曼不动杆菌20株(5.00%)。排名前4位的革兰氏阳性菌分别凝固酶阴性葡萄球菌59株(14.75%)、屎肠球菌44株(11.00%)、粪肠球菌39株(9.75%)、金黄色葡萄球菌20株(5.00%)。未发现耐碳青霉烯的大肠埃希菌,肺炎克雷伯菌对碳青霉烯酶的耐药性呈上升趋势,非发酵菌对碳青霉烯耐药相对较高。万古霉素对葡萄球菌保持较高的敏感性。结论肾移植术后患者感染主要可能是大肠埃希菌、肺炎克雷伯菌。经验性选择抗菌药物时需考虑以上病原菌的耐药情况,并及时依据药敏报告调整用药方案。针对多重耐药菌可考虑联合用药。
Objective The specific situation of bacterial resistance after kidney transplantation in a hospital during 2016—2018 was analyzed to provide reference for the empirical drug selection on bacterial infection after kidney transplantation in the First Affiliated Hospital,Sun Yat-sen University.Methods The bacterial drug resistance of 367 suspected infected patients in the kidney transplantation during 2016—2018 was retrospectively analyzed,including the distribution of bacterial etiology and the change of drug resistance.Results A total of 400 strains of bacteria were isolated in the patients after renal transplantation,among which 226 strains of gramnegative bacteria(56.50%)and 174 strains of gram-positive bacteria(43.50%)were isolated.The top four gramnegative bacteria were 61 strains of escherichia coli(15.25%),51 strains of klebsiella pneumoniae(12.75%),31 strains of pseudomonas aeruginosa(7.75%),and 20 strains of acinetobacter baumandii(5%).The top four grampositive bacteria were 59 strains of coagulase negative staphylococcus(14.75%),44 strains of enterococcus faecalis(11%),39 strains of enterococcus faecalis(9.75%)and 20 strains of staphylococcus aureus(5%),respectively.No carbapene-resistant escherichia coli was found,and klebsiella pneumoniae showed an increasing trend of resistance to carbapenenase,while non-fermentation bacteria showed relatively high resistance to carbapenenase.Vancomycin was highly sensitive to staphylococcus.Conclusion Escherichia coli and klebsiella pneumoniae were the main infections in patients after renal transplantation.When empirically selecting antimicrobial agents,it is necessary to consider the drug resistance of the above pathogenic bacteria,and timely adjust the drug regimen according to the drug sensitivity report.Combined drug use may be considered for multidrug-resistant bacteria.
作者
杨伟杰
陈杰
Yang Weijie;Chen Jie(Department of Pharmacy,Hui Ya Hospital of The First Affiliated Hospital,Sun Yatsen University,Huizhou 516081,Guangdong,China;The First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,Guangdong,China)
出处
《实用器官移植电子杂志》
2020年第1期37-41,共5页
Practical Journal of Organ Transplantation(Electronic Version)
关键词
肾移植
细菌
耐药性
Renal transplant
Bacterium
Drug resistance
