肾移植术后不同阶段感染病原学特征分析

Characteristics of the infection in various stages of post-renal transplantation.

目的探讨肾移植术后不同阶段感染的病原学特征.方法对41例2003～2004年肾移植术后感染病例进行回顾性分析,对不同阶段感染率、感染部位及病原体进行分析.结果①69例肾移植术后病例其中感染病例41例,感染率59.4%;②感染时相：30天内感染11例,占感染病例26.8%;30＜感染≤90天12例,占29.3%;90天＜感染≤180天7例,占17.1%;＞180天感染11例,占26.8%;③41例感染病例中单纯肺部感染23例,占感染病例56.1%;肺炎合并脑膜炎、肺部和胃肠道感染、神经系统感染、腹腔感染各1例,分别占2.4%;泌尿系感染5例,占12.2%;切口感染2例,占4.9%;感染部位不明确7例,占17.1%,为病毒感染;④检出病原体30例,细菌感染10例,病毒感染9例,混合感染11例,病原体不明11例.在全部感染病例中病毒检出株数巨细胞病毒（CMV）、腺病毒3（Ad3）占首位,其次依次为Eb病毒、腺病毒11（Ad11）、单纯疱疹病毒1（Hsv1）、单纯疱疹病毒2（Hsv2）、柯萨奇病毒（Cox）、风疹病毒、腺病毒7（Ad7）;在全部感染病例中细菌检出株数绿脓杆菌、表皮葡萄球菌、D群非肠球菌占首位,其次依次为嗜麦芽窄食单孢菌、大肠杆菌、屎肠球菌、鲍曼不动杆菌、阴沟肠杆菌、黄杆菌属、D群肠球菌;细菌感染病例中检出率最高的是绿脓杆菌、嗜麦芽窄食单孢菌、大肠杆菌,其次依次屎肠球菌、D群非肠球菌、鲍曼不动杆菌、阴沟肠杆菌、表皮葡萄球菌、黄杆菌属;病毒感染病例中病毒检出株数CMV、Ad3占首位,其次依次为Hsv2、Eb病毒、Cox、Ad11;⑤经积极治疗抢救34例治愈,7例死亡,死亡率17%.死亡病例除一例为腹腔感染外,余均为肺部感染.死亡病人中,APACHEⅡ评分19～24,平均22.57±3.05,死亡风险系数19.26～44.23,平均28.24±8.89.结论肾移植术后感染可发生在不同部位,以肺部感染居多;感染不同病原体,≤30 d内感染细菌、病毒居多,30 d＜感染≤90 d病原体不明、细菌居多,90 d＜感染≤180 d细菌、病毒、病原体不明、混合感染数量相近,＞180 d混合感染居多,根据不同时期感染特性可在病原学检查结果未得到前给予经验型治疗,并根据APACHEⅡ评分及死亡风险系数判断预后.

Objective To investigate etiological factors of infection in patients in various stages of post - renal transplantation. Methods Retrospective analysis was made in 41 cases of infected patients who received kidney transplant between jan. 2003 and Dec. 2004. The rate, location and etiological factors of the infection were analyzed. Results Infections developed in 41 of 69 patients （59.4 % ） following renal transplantation. Infections occurred in various stages of post - transplantation, 11 of 41 cases （26.8%） in the first 30 days, 12 cases （29.3%） from the 30th day to the 90th, 7 cases （ 17.1% ） from the 90th day tn the 180th day, and 11 cases （26, 8% ） were after the 180th day. Concerning the location of the infection, 23 of 41 cases （56, 1% ） were pulmonary infections, 1 case （2, 4% ） pneumonia complicated with meningitis, 1 case （2.4%） pneumonia complicated with intestinal infection, 5 cases （ 12.2% ） urinary infections, 2 （4, 9% ） incision infections, 1 （2.4%） nervous system infection, 1 （2.4% ） abdominal cavity infection, and 7 cases （ 17.1% ） with virus infection showed unclearly infected region. Pathogen was detected in 30 of 41 infected patients including bacteria in 10 cases, virus in 9 cases and mixed infections in 11 cases, In all infections, the numbers of isolates of Pseudomonas aeruginosa, Staphylococcus epidermidis and D group nonenterococcus from infected patients were at primacy, followed by malt Pseudomonas, Bacillus coli, Enterococcus faecium, immobile bacillus, sewer enteric bacilli, yellow bacilli, and D group enterococcus, In viral infections, the numbers of isolates of CMV and Adv3 were at primacy, followed by EB virus, Adv11, HSV1, HSV2, Cox virus, rubella vires, and Adv7 virus; in bacterial infections, the numbers of isolates of Pseudomonas aeruginosa, malt Pseudomonas and Bacillus coli were at primacy. After treatment, 34. cases recovered, 7 cases died, mortality rate was 17%, All the dead cases were pulmonary infection except one abdominal cavity infection, In dead cases, APACHE Ⅱ grade was from 19 to 24 （ 22. 57 ± 3.05 ）, death risk index was from 19. 26 to 44. 23 （28. 24 ± 8. 89）. Conclusion Infections after renal transplantation develop in various regions, pulmonary infection is most frequent. Empiric treatment based on the etiological findings of infected patient in various stages of post - renal transplantation may be useful. Pragnosis can be assessed according to the APACHE Ⅱ grade and death risk index.