肝移植术后非发酵革兰阴性菌感染的临床分布及其耐药性分析

Clinical Distribution and Antibiotic Resistance of Non-fermentative Gram-negative Bacilli Infection after Liver Transplantation

目的分析肝移植术后常见非发酵革兰阴性细菌感染临床分布特征及其耐药性。方法回顾性分析292例肝移植术后患者非发酵革兰阴性细菌感染发生部位、病原菌及其耐药性。结果33.9%的肝移植患者术后发生非发酵革兰阴性细菌感染。感染常见部位:呼吸道62.6%,胆道14.1%,菌血症12.1%,腹腔9.1%,部分为混和感染。获99株非发酵革兰阴性病原菌,最多见的依次为:鲍曼/溶血不动杆菌39.4%,铜绿假单胞菌31.3%,嗜麦芽窄食单胞菌17.2%。耐药性分析显示鲍曼/溶血不动杆菌对亚胺培南耐药率最低(10.2%),其次为头孢哌酮/舒巴坦钠(25.6%)和派拉西林/他唑巴坦(28.2%);铜绿假单胞菌对阿米卡星耐药率最低(9.7%),其次为派拉西林/他唑巴坦(22.6%)和头孢吡肟(25.8%),对头孢曲松和头孢噻肟表现出高度耐药;嗜麦芽窄食单胞菌对亚胺培南呈现天然耐药,仅对阿米卡星和环丙沙星敏感性较好。结论肝移植术后感染非发酵革兰阴性病原菌大多是耐药程度高的院内感染菌,并且常为多重耐药株,应根据药敏试验结果选用有效抗菌药。

Objective To investigate the epidemiology of non-fermentative Gram-negative bacilli infections after liver transplantation, and to analyze the antibiotic susceptibility to major pathogens. Methods A retrospective survey was conducted to 292 patients who underwent liver transplantation in the period of January 2004 and September 2006. With MieroScan Walkaway- 40 Automatic System, the non-fermentative Gram-negative bacilli infection was analyzed for the identification of pathogens and susceptibility to drugs. Results Nonfermentative Gram-negative bacilli infection was identified in 33.9% of 292 patients after liver transplantation. A total of 99 non-duplicate strains were isolated. The infection was frequently identified from respiratory tract, biliary tract, blood stream and intra-abdominal cavity. The top 3 pathogens were Acinetobacter baumannii, Pseudomonas aeruginosa and Stenotrophomonas maltophilia. Those non-fermentative Gram-negative bacilli were usually resistant to multiple antimicrobial agents. Conclusion The non-fermentative Gram-negative bacilli of postoperative infections in liver transplantation recipients are mostly multi-drug resistant. The microbiological surveillance is important for guiding clinical therapy.