肺移植术后细菌感染的菌群分布及耐药性分析

Distribution and drug resistance of pathogens for bacterial infection after lung transplantation

目的分析肺移植后细菌感染的菌群分布及耐药性，为临床预防术后感染和合理使用抗菌药物提供依据。方法回顾性分析2009年5月至2012年10月间81例受者肺移植后细菌感染的病原菌分布及耐药情况，细菌鉴定和药物敏感性试验采用法国生物梅里埃公司VITEK-32全自动微生物鉴定仪及配套药物敏感性试剂进行，数据采用SPSS（13．0版）软件进行统计分析。结果肺移植术后81例受者中有67例出现细菌感染，感染率为82．72％（67／81），其中单一菌种感染有20例，2种细菌感染23例，多种细菌混合感染24例。共分离出各类细菌病原体157株，其中革兰阳性菌占12．74％（20／157），革兰阴性菌占87．26％（137／157）。其中最常见的病原菌依次为鲍曼复合醋酸钙不动杆菌、肺炎克雷伯菌、铜绿假单胞菌、嗜麦芽窄食单胞菌、大肠杆菌及金黄色葡萄球菌，术后细菌感染多发生在术后早期（1个月内），病原菌中非发酵菌多见多重耐药。结论肺移植后细菌感染率高，应注意根据菌群分布特点和耐药情况合理使用抗生素。

Objective To analyze the distribution and drug resistance of pathogens for bacterial infection after lung transplantation, so as to provide evidence for clinical prophylactic strategies postoperation and reasonable use of antibiotics. Method The bacterial distribution and drug resistance of 81 recipients after lung transplantation in our hospital were retrospectively analyzed from May 2009 to October 2012. The VITEK-32 full-automatic microbial identification system （Biomerieux, France） and its supplementary reagent were used for bacterial identification and drug sensitive test. The data were statistically analyzed by using the software SPSS 13.0. Result There were 67 cases of bacterial infection in the 81 recipients after lung transplantation and the infection rate was 82. 72% （67/81）. The infection was caused by one kind of bacteria in 20 patients, two kinds of bacteria in 23 patients and multiple bacteria in 24 patients. 157 strains pathogenic bacteria were produced, and the gram- positive bacilli and the gram-negative bacilli accounted for 12. 74% and 87. 26% respectively. The most common pathogens for the bacterial infection were Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, Stenotrophomonasmaltophilia, Escherichia coli and Staphylococcus aureus. Most of the bacterial infections occurred in the early period （41 month） after lung transplantation and most non-fermentative bacterial pathogens were resistant to multi-antibiotics. Conclusion The bacterial infection rate is high after lung transplantation. The rational use of antibiotics in clinical practice should be adjusted according to the bacterial distribution and drugresistance.