肾移植后严重感染的病原学特征及临床诊治特点

Severe post renal transplantation infection: its etiology and clinical characteristics

目的 :研究肾移植后引起严重感染的病原学特征及相应的临床诊治特点。方法 :对 15 0 4例次肾移植患者中所发生严重感染病例进行回顾性分析。结果 :(1)肾移植后感染的发生率为 2 3.74% ,其中严重感染占 14.0 1%。 (2 ) 86 %的严重感染发生于术后半年内 ,经抗细菌、真菌、病毒、支原体与衣原体治疗后 ,救治成活率可达 82 %。 (3)引起严重感染的病原菌按出现频度高低依次为细菌 (4 2例次 ,主要为结核杆菌、绿脓杆菌、金黄色葡萄球菌、阴沟杆菌等 )、真菌 (16例次 ,主要为白念珠菌、热带念珠菌、青霉菌等 )、病毒 (12例次 ,巨细胞病毒 )。 结论 :(1)感染为肾移植后常见并发症 ,严重感染为肾移植患者的重要死亡原因。 (2 )及时诊断与联合治疗可显著提高严重感染的治愈率。 (3)肾移植后严重感染的病原菌有其特定的菌群谱 ,了解其规律对于临床及时。

Objective: To probe into the etiology of the severe post renal transplantation infection and its diagnosis and treatment. Methods: A retrospective analysis was made on the severe infected cases among 1 504 renal transplantation cases. Results: (1)The infected rate in the whole group was 23.74%,and 14.01% of the infection cases was severely involved. (2) About 86% of the severe infection occurred within 6 months after operation and as high as 82% of the patients were successfully rescued by various etiological treatment. (3) The main etiological causes according to their frequency and type were: Bacteria( Mycobacterium tuberculosis, Pseudomonas, Aureus staphylococcus, Bacillus cloacae, etc .); Fungus ( Candida albians, Candida tropicals, Penicillum patulum ). Cytomegalovirus also often appeared. Conclusion: (1) Infection is one of the common complications after renal transplantation and severe infection is an important cause of death. (2) Correct diagnosis and combined therapy in time may improve its success rate. (3) Characterized germ spectrum exists in severe post renal transplantation infection and its role is of great importance to clinical management.