肾移植术后抗生素预防性使用与绿脓杆菌的定植及感染

Antibiotic Prophylaxis and Control of Oropharyngeal Colonization of Pseudomonas aeruginosa in Renal Transplantation

本文就肾移植术后的预防性抗生素使用与控制咽部绿脓杆菌的定值及其感染作了前瞻性研究。36例上述病人分为常规抗生素治疗和改进治疗两组各18人。肾移植术后常规治疗组病人咽部定植绿脓杆菌的16人(88.89%),发生绿脓杆菌继发感染的7人,感染率为38.89%。改进治疗组中,18例病人咽部定植绿脓杆菌的5人(27.78%),发生感染的1人,感染率为5.56%,此组患者感染明显低于常规治疗组(P<0.05)。绿脓杆菌的血清型83.15%为第四群6型。质粒分析表明咽部定植绿脓杆菌的同感染灶上的绿脓杆菌具有相同的质粒图谱。作者认为:肾移植术后预防性使用抗生素可以有效地预防术后感染,但必须控制抗生素的疗程和剂量,否则将会导致机体正常菌群微生态平衡失调,耐药性绿脓杆菌定植于局部,极易造成感染的爆发.

A prospective study was designed to deter- mine the relationship between antibiotic prophylaxis,oropharyngeal colonization of P. aeruginosa and risk of post-surgical infection 36 patients were divided into conventional therapy group and improving therapy group depended on different antibiotic therapy(18 cases for each group).16 Cases in the con- ventional prophylaxic group(88.89%)were colonized by P.aeruginosa and 7 were infected by this bacteria(infected rate being 38.89%). After improving antibiotic treatment,5 pati- ents(27.78%)were colonized by P.aeraginosa and only one of the patients was so infected. The infective rate was 5.56% which appeared to be significantly lower than the conventior- al therapy group(P<0.05).83.15% of the P.aeruginoda sero-group were group 6 of se- rum pool Ⅳ.Almost all P.aeruginosa isolated from the patients were found to carry the same “R”(resistant)plasmid. We conclude that antibiotic prophylaxis is necessary which proved to provent post-surgic- al infection effectively.However,because anti- biotic therapy can destroy normal flora of the patients,and induce colonization of resistant microbes,resulting in infective nosocomial outbreak.Therefore the dose of antibiotics and the period of the prophylaxis therapy must be considered & under control.