肝移植术后革兰氏阳性球菌感染的预防

Prevention of gram-positive cocci infection after liver transplantation

目的研究口服万古霉素对肝移植术后革兰氏阳性球菌感染的预防作用。方法将2005年9月至2006年9月行肝移植手术的80例患者分为万古霉素组（40例）和对照组（40例），两组均静脉滴注用氧哌嗪青霉素＋他唑巴坦。万古霉素组患者术后第1～7天口服或经胃管注入万古霉素并进行血药浓度监测。观察两组患者术后感染的发生情况。结果万古霉素组和对照组发生革兰氏阳性球菌感染分别为7例和15例，其中耐甲氧西林金黄色葡萄球菌分别为3例和10例，两组比较差异有统计学意义（X^2=4．501，P〈0．05）；万古霉素组和对照组术后发生胃肠道菌群失调分别为3例和10例，两组比较差异有统计学意义（X^2=4．501，P〈0．05）。两组革兰氏阴性杆菌和真菌感染例数比较差异无统计学意义（X^2=0．065，0．251，P〉0．05）。万古霉素组患者血液中万古霉素浓度均为零。结论口服万古霉素对预防肝移植术后革兰氏阳性球菌感染和胃肠道菌群失调是安全有效的。

Objective To investigate the prevention of gram-positive cocci infection by oral administration of vancomycin after liver transplantation. Methods Eighty patients who underwent liver transplantation from September 2005 to September 2006 were divided into vancomycin group and control group. All the patients were intravenously infused with piperacillin ＋ tazobatam to prevent infection after liver transplantation. Patients in vancomycin group were given vancomycin orally in the first 7 days after liver transplantation and vancomycin concentration in the blood were measured at the same time. Infection and stool cocci and bacilli ratio of the patients in the 2 groups were observed. Results Seven patients in vancomycin group and 15 patients in control group （including 3 and 10 patients infected with methicillin resistant staphylococcus aureus in each group） were infected with gram- positive cocci, respectively, with statistical difference （X^2 = 4. 501, P 〈 0.05）. Three patients in vancomycin group and 10 patients in control group presented with imbalance of gastrointestinal flora, with statistical difference （X^2 = 4.501, P 〈 0.05）. No statistical difference was found in the patients infected with gram-negative bacilli or fungi between the 2 groups （X^2 = 0.065, 0.251, P 〉 0.05）. The vancomycin concentration was 0 in the blood of patients who simply took vancomycin. Conclusions It is safe and effective to take vancomycin orally to prevent gram-positive cocci infection and imbalance of gastrointestinal flora after liver transplantation.