肾移植术后颈内静脉留置导管细菌定植情况调查

Investigation of jugular catheter bacterial colonization after renal transplantation

目的了解肾移植术后颈内静脉留置导管细菌定植情况及耐药性的特点,为预防肾移植术后导管相关感染提供可靠的依据。方法对住院的49例肾移植受者在术后第2天、第4天进行导管腔内血培养和拔除导管时导管尖端培养,对分离菌株进行鉴定和药敏试验。结果共收集细菌培养标本113份,其中,术后第2天标本42份,术后第4天标本48份,导管尖端标本23份,培养阳性率分别为2.4%(1/42)、29.2%(14/48)和65.2%(15/23)。术后第4天培养阳性率较术后第2天明显上升。培养获得的菌株以葡萄球菌为主。结论随着使用时间的延长,导管内细菌定植几率增加。临床上需严格无菌操作技术,根据药敏试验结果应用抗生素封管,减少导管相关感染。

Objective To analyze the characteristics of bacterial colonization and drug resistance in catheter insertion through internal jugular vein,and provide a reliable basis for the prevention of catheter-related infection after kidney trans- plantation. Methods The strains of bacteria isolated from catheter cavity blood culture at the second and fourth day after renal transplantation and the catheter tip culture in 49 cases were analysed by Vitek instruments of French M6rieux company. Results A total of 113 samples were collected,including 42 samples of catheter cavity blood culture at the second day after renal transplantation,48 samples at the fourth day after renal transplantation,and 23 samples of catheter tip culture. The posi- tive rates were 2.4% （1/42）,29.2% （14/48） and 65.2% （15/23）,respectively. The positive rate at the fourth day after renal transplantation was significantly higher than that of the second day. The top three isolated bacteria were Staphylococcus epidermidis,Staphylococcus simulans and Corynebacterium. Conclusion The incidence of bacterial colonization in internal jugular vein indwelling catheter increased as time prolonging. It is suggested to strictly execute aseptic techniques and use an- tibiotics according to drug resistance analysis to reduce the catheter-related infection in kidney transplant patients.