肾移植术后难治性发热病原菌与疗效分析

The pathogens and effect analysis for patients with incurable fever in postrenal transplantation

目的 :探讨肾移植术后感染所致发热的临床和病原学特点与规律。方法 :收集 2 0例肾移植术后因难治性发热住入综合 ICU患者的临床资料 ,分析发热时间、热型、临床症状、病原学检查结果。结果 :肾移植术后1～ 6个月患者发热发生率最高 (15例 ) ,高热 (10例 )与不规则发热 (7例 )居多。肺部感染发生率 (2 4例 )最高(革兰阴性杆菌 15例 ,真菌 7例 ,结核菌 1例 ,巨细胞病毒 1例 ) ,泌尿系感染 (11例 ,其中真菌感染 8例 ,革兰阴性杆菌 3例 )次之。革兰阴性杆菌与真菌性败血症也有发生 (各 3例 ) ,其中 2例同时存在革兰阴性杆菌和真菌 ,单纯绿脓杆菌败血症 1例。 1例深静脉导管培养发现阴沟杆菌 ;1例有真菌性心肌炎伴脓肿形成和肺部白色念珠菌感染 ,尸检肺部检出巨细胞病毒合胞体 ;1例全身系统性 (肺、泌尿系统、血液 )真菌感染合并肺外结核感染。结论 :肾移植术后感染所致发热最容易出现在术后 1～ 6个月内 ;肺部细菌与真菌混合感染最多见 ,泌尿系统真菌感染次之 ,结核感染 (肺内或肺外 )也不能忽视 ,抗感染和抗真菌疗效不佳时应考虑到结核感染。

Objective:To investigate the clinical and pathogenic features of incurable fever resulting from infection in patients with renal transplantation.Methods:Clinical data in 20 patients who suffered from incurable fever after renal transplantation was collected in general ICU.The fever types,the duration when fever presented after renal transplantation, the clinical symptoms and the pathogens were analyzed respectively. Results: The fever occurred frequently during the first to sixth month(75.0%) after renal transplantation.The high(50.0%) and irregularfever (35.0%) were common.The most popular infection was in lungs with gramnegative bacilli(15 cases)and the fugal(7 cases).And then it was the urinal infection with the fugal( 8 cases ).The sepsis with gramnegative bacilli (3 cases) and the fugal (3 cases) occurred and both of them also could be present at the same time(2 cases).Among the patients with pulmonary infection,8 cases were infected by gramnegative bacilli infection(40.0%), 6 combined with fugal (30.0%),1 combined with tuberculosis(5.0%)and 1 combined with cytomegalovirus(5.0%).Only 1 case was systemic fugal infection including lung,urinal and sepsis combined with tuberculosis out of lung(5.0%).Conclusions:Fever in patients with post renal transplantation is always occurred during 1 to 6 month after transplantation.Pulmonary mixed infection is the most frequent type with bacterial and fungus,and the second type is urinary infection with fungus.The tuberculosis infection (in and out of lung) should never be ignored.As soon as the treatment on antibacterial and fungus were not effective,the tuberculosis infection should be considered as earlier as we can.