肝移植患者感染病原学和抗菌药物使用情况分析

Analysis on Infection Etiology and Use Situation of Antibacterial Drugs in Patients Undergoing Liver Transplantation

目的分析肝移植患者术后感染的病原菌分布及耐药性特点,指导临床合理应用抗菌药物。方法对2010年1月至2013年12月某三甲医院肝移植患者术后送检的各类标本分离出的病原菌及抗菌药物使用进行回顾性分析。结果共分离出病原菌117株,其中革兰阴性菌占59.83%,革兰阳性菌占33.33%,真菌占6.84%;主要病原菌依次为鲍曼不动杆菌(33.33%)、屎肠球菌(23.93%)、肺炎克雷伯菌(12.82%)。革兰阴性杆菌对碳青霉烯类耐药率最低,未发现对糖肽类及唑烷酮类耐药的革兰阳性球菌。结论该院肝移植患者术后感染的病原菌以革兰阴性菌为主,病原菌呈多药耐药性,根据病原菌分布和耐药性特点合理选择抗菌药物非常重要。

Objective To observe the pathogenic bacteria distribution of postoperative infections in the patients undergoing liver trans- plantation and the drug resistance characteristics so as to guide the rational use of antibacterial drugs in clinic. Methods The related data of pathogenic bacteria isolated from the various specimens and the use situation of antibacterial drugs in postoperative patients un- dergoing liver transplantation in a class 3A hospital from January 2010 to December 2013 were analyzed retrospectively. Results Totally 117 strains of pathogenic bacteria were isolated, in which Gram-negative bacteria accounted for 59.83%, Gram-positive bacteria ac- counted for 33.33% and fungi accounted for 6.84%;major pathogenic bacteria were in turn Acinetobacter baumannii （33.33%）, Ente- rococcus faecium（23.93% ） and Klebsiella pneumoniae （12.82%）. The Gram-negative bacteria had the lowest resistance to carbopen- ems, no glycopeptide- resistant and oxazolidinone- resistant Grampositive cocci were found. Conclusion Pathogens of postoperative in- fections in the patients undergoing liver transplantation are mainly Gram-negative bacteria and demonstrate the multidrug resistance. Therefore it is very important to rationally select antibacterial drugs according to the pathogenic bacterial distribution and drug re- sistance characteristics.