肝癌肝移植患者术后感染情况及影响因素分析

Retrospective Study of Postoperative Infection in Patients with Hepatoma Undergoing Liver Transplantation

目的调查肝癌患者肝移植术后引起感染的病原菌分布与耐药情况并探讨感染的相关因素。方法回顾性调查中山大学肿瘤医院在2003年9月至2005年8月间的肝癌肝移植患者的病历资料并进行统计学分析。结果32例肝癌患者在肝移植术后1个月内29例(90.6%)出现一个部位或以上的细菌培养阳性,从呼吸道、腹腔、泌尿道共分离出病原菌119株。感染以呼吸道和腹腔最常见,各有22例(68.8%),第1周内发生率最高。119株病原体的分布比较分散,其中葡萄球菌占31.09%(64.86%为MRSE/MRSA),白假丝酵母菌占6.72%,阴沟肠杆菌和嗜麦芽窄食单胞菌各占5.88%,产ESBLs酶的肠杆菌科菌株占G-杆菌的19.30%。术后ALB水平有下降趋势,但第1个月内尚正常。免疫抑制剂FK506术后第1个月内平均血药浓度(11.64!g/L)高于第2个月,其中尤以第1周最高。结论肝移植术后1个月内呼吸道和腹腔感染发生率较高。G+球菌和G-杆菌感染机会均等,其余为真菌,约占一成多。G+球菌以葡萄球菌为主,MRSE/MRSA比例较高,G-杆菌以阴沟肠杆菌和嗜麦芽窄食单胞菌为主,真菌以白假丝酵母菌最多。营养、免疫抑制剂及手术本身可能是导致术后高感染率的重要易感因素。

Objective To investigate the characteristics of post-graft infections in hepatoma patients and the related factors. Method Retrospective study and statistical analysis of the clinical records of 32 subjects undergoing liver transplantation from Sep. 2003 to Aug. 2005 in our Cancer Center, Sun Yat-sen University. Result 90.6% of germiculture samples （29/32 patients） were found positive. In these infected patients, 68.8% had the infection of one or more than one organs, predominantly in respiratory tract and abdominal cavity. Totally 119 pathogens were isolated from the respiratory tract, abdominal cavity and urinary tract. Among the identified pathogens, 31.09% were Staphylococci （64.86% of which were MRSE/MRSA）, 6.72% were Monilia albicans, and 5.88% were Aerobacter cloacae and Pseudomonas mahophilia. 19.30% of then isolated Gram negative bacilli were ESBL producing strains. Infections were frequently observed in the first week after operation. Serum ALB levels was decreased gradually after operation, but the level was maintained in the normal range in the first month. Serum level of the immunodepressant FKS06 reached maximum in the 1st week, and the concentration of FKS06 was around 11.64 μg/L in the 1st month. The level of FKS06 was then decreased in the second month. Conclusion In liver cancer patients, the incidence of postoperative infection was high in the first month after liver transplantation. Gram-positive cocci （mainly MRSE/ MRSA Staphylococci） and Gram-negative bacilli （mainly Aerobacter cloacae and Pseudomonas mahophilia） were the predominant species in infection. Monilia albicans is the major species of fungal infection（10%）. Nutritional status, state of immunodepression and other surgery-associated factors appear to play the key role in postoperative infection.