肝移植病区与非肝移植病区细菌感染与耐药性监测的比较

Comparison of pathogen and drug-resistance of bacterial infection between liver transplantation and non-liver transplantation ward

目的比较肝移植病区与非肝移植病区细菌菌种分布及耐药情况。方法对2008年1月1日至12月31日在中山大学附属第三医院肝移植病区和非肝移植病区住院患者的病原菌阳性标本进行分析。比较两个病区的菌株分布和耐药性。结果肝移植病区共检出菌株116株,其中革兰阴性(G-)杆菌占60.3%,革兰阳性(G+)球菌占39.7%。非肝移植病区共检出菌株1791株,G-杆菌和G+球菌分别占53.1%和46.9%。非肝移植病区检出的G-杆菌中,肠杆菌科细菌占57.2%,非发酵菌占32.2%;而肝移植病区非发酵菌占64.3%,肠杆菌科细菌占30%,两者差异有统计学意义(P<0.01)。肝移植病区检出的大肠埃希菌和肺炎克雷伯菌中超广谱β-内酰胺酶(extended spectrumβ-lactamases,ESBLs)检出率明显高于非肝移植病区,分别为80.0%、51.1%,87.5%、48.9%(均为P<0.05)。非肝移植病区未发现泛耐药G-杆菌,肝移植病区检出2株泛耐药的铜绿假单胞菌、1株鲍曼不动杆菌或溶血不动杆菌。非肝移植病区中1.9%肠球菌属对万古霉素耐药,肝移植病区为20%,比较差异有统计学意义(P<0.01)。肝移植病区检出的3株金黄色葡萄球菌均为耐甲氧西林金黄色葡萄球菌,而非肝移植病区相应为41.6%。结论肝移植病区和非肝移植病区病原菌的菌种分布不同。与非肝移植病区比较,肝移植病区检出的病原菌耐药率明显增高。

Objective To compare the pathogen and drug-resistance of bacterial infection between liver transplantation（LT）and non-liver transplantation（NLT）wards.Methods Positive samples of all inpatients from LT and NLT wards of the Third Affiliated Hospital of Sun Yat-sen University were collected from Ja-nuary 2008 to December 2008.The character and distribution of pathogen and drug-resistance in the two wards were analyzed and compared.Results One hundred and sixteen strains were isolated from LT ward,among which 60.3% was Gram negative（G^-）bacilli and 39.7% was Gram positive（G^＋）bacilli.One thousand seven hundreds and ninety-one strains were isolated from NLT ward,among which 53.1% was G^-bacilli and 46.9% was G^＋ bacilli.Among the G^-bacilli in NLT ward,Enterobacteriaceae accounted for 57.2% and non-fermentative bacilli for 32.2%.However,Enterobacteriaceae accounted for 30% and non-fermentative bacilli for 64.3% in LT ward.There was significant difference of G^-bacilli distribution between two wards（P〈0.01）.The detection rate of extended spectrum β-lactamases（ESBLs）in Enterobacteriaceae coli.and Klebsiella was significant higher in LT ward than that in NLT ward（80.0% vs 51.1%,87.5% vs 48.9%,all in P〈0.05）.Pan-resistant isolates of pseudomonas aeruginosa（2 strains）and Acinetobacter baumanii（1 strain）were emerged in LT,while no pan-resistant G^-bacilli was detected from NLT.The detection rate of Vancomycin resistant Enterococcus was higher in LT than that in NLT ward（P〈0.01）,which was 1.9% vs 20%.Three strains methicillin-resistant Staphylococcus aureus were isolated in LT ward and the detection rate of methicillin-resistant Staphylococcus aureus in NLT was 41.6%.Conclusion The distribution of pathogen is different between the LT and NLT wards.The drug-resistant rate is higher in LT than that in NLT ward.