抗生素和免疫抑制剂的个体化用药对肝移植受体术后感染的影响

Effects of individual antibiotic and immunosuppressive regime on postoperative infection in liver transplant recipients

目的评价采用抗生素和免疫抑制剂的个体化治疗方案对肝移植受体术后感染的影响。方法回顾性分析采用抗生素和免疫抑制剂的个体化用药对31例肝移植受体术后的感染发生率、病原菌谱以及病死率的影响。结果住院期间发生感染15例次,常见病原菌为阴沟肠杆菌、铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌、表皮葡萄球菌等,根据药敏试验,主要以泰能、他格适或特治星进行治疗。通过控制免疫抑制剂的血药浓度,术后感染率(48.4%)显著低于2003年之前移植病例的感染率(86.7%),P<0.05。细菌和真菌感染率明显减少(P<0.05),巨细胞病毒(CMV)感染率差异无统计学意义(P>0.05)。结论抗生素和免疫抑制剂的个体化应用,可以明显减少肝移植受体术后发生感染和其他并发症的风险。

Objective To determine the effects of individual antibiotic and immunosuppressive regime on postoperative infection in liver transplant recipients. Method There were 31 cases of liver transplantation from March 2001 to May 2005. The recipients received individual antibiotic and immunosuppressive regime based on the drug susceptibility testing and monitoring of blood drug concentration. The incidence and pattern of infection and the mortality in these recipients were analyzed retrospectively. Results There were 15 episodes of infection during recipients＇staying in hospital. The common etiologies were Enterobacter cloacae, pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii, and Staph. epidermidis. According to the drug sensitive test, targocid/tienam and tazocin were mostly used in antibiotic regime for treatment of postoperative infection. With monitoring of blood concentration, appropriate application of immunosuppressive agents decreased the incidence of infection from 86.7% before 2003 to 48.4% after 2003 （ P 〈 0.05 ）. The infection with bacteria and fungus reduced significantly （P〈0.05）, and the CMV infection had no alteration （P〉0.05）. Conclusion Individual application of antibiotic and immunosuppressive regime leads to the suppression of infections and other complications in liver transplant recipients.