原位肝移植术后感染病原菌分布及耐药分析

Distribution and drug resistance of infection pathogens after orthotopic liver transplantation

目的探讨原位肝移植术后感染的病原菌分布及其耐药性,提高肝移植术后感染的诊治水平。方法对250例原位肝移植术后感染病人的病原菌分布及药敏结果进行回顾性分析。结果肝移植术后感染率为65.2%,共分离出病原菌482株。病原菌中细菌占84.2%,其中革兰阴性菌54.2%,革兰阳性菌45.8%,其次为真菌(15.8%)。最常见的感染部位是血液、泌尿道和呼吸道,感染大多发生在肝移植术后1个月内。血液及呼吸道的感染以革兰阴性菌为主,而泌尿道感染以革兰阳性菌为主。常见革兰阴性菌及革兰阳性菌多数为多重耐药菌。结论原位肝移植术后细菌感染率高,并以多重耐药菌为主,不同感染部位主要病原菌也不同。使用抗生素治疗时需综合考虑病原菌分布特点及其多重耐药性。

Purpose To explore the distribution and the resistance of infectious pathogen in patients after orthotopic liver transplantation （OLT）. Methods The clinical data of pathogen distribution and antibiotic-resistance of 250 OLTcases were retrospectively analysed. Results The incidence of infection of transplanted liver was 65.2 %. Up to 482 pathogens were isolated from various specimen. Pathogens of infection in OLT was dominated by the bacterium （84.2%）, which was followed by fungus （15.8%）. The Gram-negative （G-） bacilli accounted for 54.2% of all bacilli while Gram-positive （G ＋ ） bacilli accounted for 45.8%. Blood, urinary tract and respiratory tract were the most common infectious sites. Most of the infection occurred within the first month after OLT. The main infected strains were G- bacteria in blood or respiratory tract, while G ＋ bacteria were mainly in the urinary tract. Most G- bacteria and G ＋ bacteria were antibiotic multi-resistant bacteria. Conclusions The bacteria infection rate was high after OLT. Most of the pathogens were antibiotics multi-resistant and the main pathogens from different infectious sites were different. For appropriate use of antibiotics, it is important to pay attention to the distribution and antibiotic-resistance of infectious pathogen after OLT.