肾移植术后早期感染类型分析

Analysis of early infections after kidney transplantation

目的总结肾移植术后早期感染的类型、原因及死亡率,以提高其生存率。方法对1102例肾移植术后发生感染的298例住院患者临床资料进行回顾性分析,总结感染类型、病原体、预后等。结果肾移植术后早期感染率为27.04%,其中肺部269例,泌尿系统15例,消化道9例,切口3例,颅内及全身各1例;应用抗胸腺细胞球蛋白(ATG)后感染率达59.35%;病原体以革兰阴性菌为主占64.77%,革兰阳性菌占19.80%,真菌占6.71%,卡氏肺孢子虫占4.03%,病毒占3.02%;感染率中男女无差异,男性发生感染后死亡及切除移植肾比例较高。结论肾移植术后早期感染患者有一定的规律,应合理应用免疫抑制剂,加强肺部感染的早期诊断和全身支持治疗,尤其是男性患者。

OBJECTIVE To summarize the types and causes of early infections after kidney transplantation and observe the mortality so as to improve the survival rate. METHODS Totally 298 patients with the postoperative infections in 1102 hospitalized patients who underwent the kidney transplantation were enrolled in the study, and the medical records were retrospectively analyzed, then the types of infections, the species of pathogens, and the prognosis were summarized. RESULTS The incidence of early infections after kidney transplantation was 27.04 %, there were 269 cases with pulmonary infections, 15 cases with urinary tract infections, 9 cases with digestive tract infections, 3 cases with incision infections, 1 case with intracranial infection, and 1 case with systemic infection. After the application of thymoglobulin（ATG）, the infection rate was 59.35%. Of all the pathogens, the gram- negative bacteria accounted for 64.77%, the gram-positive bacteria 19.80%, the fungi 6.71%, card pneumocysi- tis carinii 4.03%and the viruses 3.02%, There was no difference in the infection rate between the males and the females, and the mortality of the male patients with postoperative infections was higher, with the proportion of resection of kidney transplantation even larger. CONCLUSION There are certain rules of the patients with early infections after kindey transplantation. It is necessary to reasonably use immunosuppressants and strengthen the early diagnosis of pulmonary infections and the systemic supportive treatment, especially for the male patients.