肝移植术后早期深部真菌感染的危险因素分析及预防

Analysis and prophylaxis of the risk factors for fungal infection following liver transplantation

目的探讨肝移植术后早期深部真菌感染的临床特点及危险因素,为临床防治提供参考和依据。方法回顾性分析4年半所施行的118例肝移植患者的临床资料。选取围手术期44个独立变量进行单因素分析及Logistic回归分析,筛选出与肝移植术后早期真菌感染相关的危险因素。结果26例发生深部真菌感染,患病率为22.0%。共分离出49株真菌,以白色念珠菌为主(57.1%)。感染发生的平均时间为术后13.6 d。感染部位主要发生在呼吸道(75.5%)。Logistic回归分析结果显示:术前肝衰竭,有创机械通气时间≥48 h,胸腔积液,ICU留观时间≥5 d,使用抗生素≥3种且时间≥2周等是术后早期真菌感染的危险因素。术后预防性使用抗真菌药的患者其真菌感染率低于未预防用药者(P<0.05)。结论多种因素可以导致肝移植术后早期真菌感染,提示有效控制相关的危险因素是降低术后真菌感染发生率的关键。对高危患者预防性抗真菌治疗有助于降低术后真菌感染率。

Objective To investigate the risk factors and the clinical findings associated with fungal infection during early postoperative period after liver transplantation（LT）.Methods The clinical data of 118 cases of liver transplantation performed during past four and a half years in Nanfang Hospital were studied retrospectively.Forty-four independent variable factors were analyzed by univariate analysis and logistic regression to screen out the risk factors for early fungal infcction after LT.Results Fungal infections occurred in 26 cases（22.0%）,and the mean time was 13.6 d.A total of 49 fungi strains were isolated,of which mainly was Candida albicans（57.1%）.The most common infection site was the respiratory tract（75.5%）.Logistic regression analysis showed that pre-operative liver failure,duration of mechanical ventilation over 48 hours,pleural effusion,observation in ICU for more than 5 days,and the use of more than 3 kinds of antibiotics and for longer than 2 weeks were risk factors.The infection rate was lower in patients with prophylactic administration of antifungal ugents than patients without prophylactic administration.（P0.05）.Conclusions Because multiple risk factors can lead to fungal infections following liver transplantation,it is important to make effective control of these factors and thus reduce the incidence of fungal infection.The use of antifungal agents for prophylaxis in high-risk LT patients is associated with a low incidence of serious fungal infection.