肝移植术后细菌感染病原学特征的研究

Epidemiology of Bacterial Infection in Early Stage after Liver Transplantation

目的研究肝移植术后细菌感染的病原学特征,提供治疗指导。方法回顾性分析139例患者,141次原位肝移植术后细菌学资料。结果肝移植术后细菌感染率为29.4%,6例因感染死亡,与感染相关的死亡率4.3%;89.7%的细菌感染发生在术后1个月内;易感器官依次为腹腔、呼吸道和胆道,感染率分别为35.3%、26.4%、19.1%;共分离出菌株639株,其中革兰阴性(G-)杆菌占38.8%,革兰阳性(G+)球菌占61.2%;最常见的G-杆菌依次为铜绿假单胞菌、鲍氏/溶血不动杆菌、大肠埃希菌、阴沟肠杆菌、肺炎克雷伯菌,最常见的G+球菌为屎肠球菌、溶血葡萄球菌、MRSE、MRSA、粪肠球菌。结论肝移植术后细菌感染是影响预后的重要因素;感染以高度耐药菌为主,应加强对移植前后病原学的监测;肝移植术后细菌感染部位与菌群有明显相关性。

OBJECTIVE To analyze the epidemiology characteristic of bacterial infection after liver transplantation, and provide a basis to improve prophylaxis and empiric therapy. METHODS A retrospective survey in 139 patients who underwent 141 orthotopic liver transplantation was carried out. The infection incidence, time, infected site and pathogen were collected. RESULTS The bacterial infection incidence after liver transplantation was 29.4% and 6 patients died of bacterial infection. 89.7% infection episodes occurred in first month after transplantation. Pseudomonas aeruginosa was the most frequent Gram-negative bacillus, and the most prevalent Gram-positive pathogen was Enterococcus. The most common infected sites were the abdomen, respiratory tract and biliary tract. CONCLUSIONS Post-transplantation bacterial infection plays an important role on affecting the prognosis. Most of pathogens are antibiotics resistant, and pathogen monitoring should be emphasized. There are significant relationship between the site and pathogen of bacterial infection, and this epidemiology of bacterial infections can help clinical therapy.