肝移植术后感染患者病原菌特征及耐药性分析

Analysis of distribution and drug resistance of pathogenic bacteria causing postoperative infection in patients after liver transplantation

目的 分析肝移植术后感染患者病原菌的分布及耐药性特点.方法 回顾性分析2011年1月至2014年12月于首都医科大学附属北京朝阳医院行肝移植手术的113例患者临床资料,分析术后感染患者的病原菌分布及药物敏感性试验结果.结果 35例术后发生感染,感染率为31.0％.感染部位共47处,肺部感染占57.5％（27/47）、腹腔感染占25.5％（12/47）、胆道感染占6.4％ （3/47）、血液感染占4.3％ （2/47）、切口感染占4.3％ （2/47）、泌尿系统感染占2.1％ （1/47）.共分离出病原菌103株,其中革兰阴性菌77株,占74.8％,主要包括鲍曼不动杆菌（28株）、肺炎克雷伯菌（25株）、铜绿假单胞菌（14株）;革兰阳性菌18株,占17.5％,主要为屎肠球菌（9株）;真菌8株,占7.8％.103株病原菌中,痰液标本中检出的病原菌数量最多,为33株,占32.0％;其次为腹腔积液,共检出病原菌28株,占27.2％.病原菌总体耐药性高,且呈多重耐药.结论 肝移植术后医院内感染发生率较高,尤以呼吸道感染多见,病原菌以鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌为主;培养出病原菌均存在较高的耐药性。

Objective To analyze the distribution and drug resistance of pathogenic bacteria causing postoperative infection in patients after liver transplantation.Methods Totally 35 patients undergoing liver transplantation from January 2011 to December 2014 were retrospectively analyzed.The distribution of isolated pathogen and the results of drug susceptibility test in patients with infection were assessed.Results Totally 35 patients suffered from postoperative infection, with incidence of 31.0%.There were 47 infected sites, including lung [57.5 % （27/47）], abdomen [25.5% （12/47）], biliary tract [6.4% （3/47）], blood [4.3 % （2/47）], incision [4.3% （2/47）] and urinary [2.1% （1/47）].A total of 103 strains of pathogen were isolated;there were 77 Gram negative strains （74.8%）, mainly including 28 strains of acinetobacter baumannii, 25 strains of klebsiella pneumoniae reber and 14 strains of pseudomonas aeruginosa;there were 18 Gram positive strains （17.5%）, mainly including 9 strains of enterococcus feces;there were 8 fungus.In 103 strains, there were 33 strains （32.0%） separated from sputum sample, being the most, followed by 28 strains （27.2%） separated from seroperitoneum sample.The pathogens showed high drug resistance, moreover being muhi-drug resistant.Conclusion The incidence of infection after liver transplantation, especially respiratory infection is high;the pathogens are mainly acinetobacter baumannii, klebsiella pneumoniae reber and pseudomonas aeruginosa;the isolated pathogens have high drug resistance.