肾移植术后细菌感染的菌群分布及其药敏分析

Distribution and drug resistance of bacterial infection in the patients after kidney transplantation

目的 了解肾移植术后感染的病原菌分布及耐药性特点,为临床治疗肾移植术后感染的合理用药提供依据.方法 收集2006年1月至2010年12月我院220例肾移植患者术后送检的各类标本中分离的病原菌,细菌鉴定采用API鉴定系统,药敏试验采用K-B纸片扩散法,采用WHONET5.4软件对药敏结果进行分析.结果 220例肾移植患者术后感染的发生率为31.4％,病原菌分离部位主要以痰液、血液、尿液为主,占73.8％.共分离出病原菌84株,较常见的病原菌依次为：铜绿假单胞菌14株（16.7％）、大肠埃希菌12株（14.3％）、表皮葡萄球菌12株（14.3％）、金黄色葡萄球菌9株（10.7％）、肺炎克雷伯菌7株（8.3％）和白色假丝酵母5株（6.0％）.大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶的检出率分别为50.0％和14.3％,表皮葡萄球菌和金黄色葡萄球菌中的耐甲氧西林葡萄球菌检出率分别为58.3％和33.3％.主要革兰阳性球菌对万古霉素和替考拉宁敏感,革兰阴性杆菌对亚胺培南、美洛培南敏感.结论 感染是肾移植术后的主要并发症之一,应加强耐药监测,及早进行预防和治疗.

Objective To investigate the distribution and drug resistance of pathogenic bacteria in the patients after kidney transplantation. Methods The pathogenic bacteria isolated from the samples of 220 pa- tients after kidney transplantation in our hospital from January 2006 to December 2010 were collected. API i- dentification system was used to identify bacteria, and drug sensitive test were done with K-B paper strips dif- fusion method. The results were analyzed by WHONET 5.4 software. Results The incidence rate of infection after kidney transplantation was 31.4%. The main sites for pathogenic bacteria were sputum, blood and urine （73.8%）. Totally 84 strains were separated, the most common strains were Pseudomonas aerug/nosa（16.7%）, Es- cherichia coli（14.3%）, Staphylococcus epidermidis（14.3% ）, Staphylococcus aureus（10.7%）, Klebsiella pneumo- niae （8.3%） and Candida albicans （6.0%）. The detection rate of strains producing extended spectrum [3 laeta- mases were 50.0%（Escherichia coli） and 14.3%（Klebsiellapneurnoniae）. And the detection rate of methicillin- resistant Staphylococcus were 58.3% （Staphylococcus epidermidis） and 33.3% （Staphylococcus aureus）. The main Gram-positive coccus were sensitive to vaneomycin and teicoplanin. The main Gram-negative bacilli were sensitive to imipenem and meropenem. Conduslon Infection is a major complication after kidney trans- plantation. It is very important to strengthen drug resistance surveillance, and undertake prevention and treat- ment early.