供者强化预防真菌感染方案在器官捐献中的应用及效果分析

A clinical analysis on strengthening prevention strategies for DCD donor fungal infection

目的 分析强化预防真菌感染方案在器官捐献中的应用效果.方法 回顾性分析华中科技大学同济医学院附属同济医院2015年1月至2015年8月（第一阶段）以及2015年9月至2016年12月（第二阶段）共261例供者的抗真菌维护方案及其临床效果.第一阶段（供者普通管理阶段）,处理措施主要以重症监护病房（ICU）医生进行供者维护为主,不常规应用抗真菌药物,器官获取及修整无特殊处理.第二阶段（供者强化预防阶段）,处理措施主要包括：（1）ICU停留期间,加强抗真菌治疗;（2）供者器官获取时严格强化无菌操作;（3）供者器官修整过程中,采取广谱抗生素或稀释的络合碘溶液冲洗浸泡器官.留取供者1 574份血液、灌洗液及动脉组织微生物培养样本进行病原菌检测.其中真菌培养样本626份,按照样本留取时间分为供者普通管理阶段样本193份,供者强化预防阶段样本433份.结果 1 574份微生物培养样本中共分离出病原菌907株,其中细菌799株,真菌108株,部分样本可检出2～3株病原菌.真菌检出率占病原菌检出率的12.0％（108/907）,占真菌培养样本的17.3％（108/626）.所检出的108株真菌样本中,属于供者普通管理阶段的阳性样本49株,阳性率为25.4％（49/193）,属于供者强化预防阶段的阳性样本59株,占13.6％（59/433）,两阶段真菌阳性检出率相比较,差异有统计学意义（P＜0.05）.结论 加强潜在供者的微生物培养及抗真菌预防策略,对于减少供者来源的真菌感染十分必要.此外,器官获取团队也需要提高对供者来源真菌感染的认识程度,严格强化无菌操作,尽可能避免不必要的污染因素.而在器官修整过程中,采取广谱抗生素或稀释的络合碘冲洗浸泡也不失为一种可以考虑的感染预防措施.

Objective To analyze the clinical effects of the diverse prevention strategies on donation after citizen＆#39;s death （DCD） donor fungal infection.Methods A retrospective study was performed on the clinical data of the antifungal preventive scheme to 261 DCD donors from January 2015 to August 2015 （the first period） and September 2015 to December 2016 （the second period） in Tongji Hospital.During the first period,the donors were administrated by ICU doctors and the antifungal agents were not applied as routine.The processes of organ procurement and trim were in accordance with the past experience.During the second period,the donor maintenance was reinforced,including antifungal preventive scheme,aseptic manipulation of organ procurement and rinsing and immersing allografts with broad-spectrum antibiotics or diluting povidone-iodine solutions during organ trim.Microbial culture specimens were performed in 1 574 samples including blood samples,perfusion fluids and arterial tissues and the pathogen distribution at the different periods was identified.Result In the microbial culture specimens of 1 574 samples,907 strains of pathogens were detected,including 799 strains of bacteria and 108 strains of fungi.The positive rate of fungi was 12.0％ （108/907） of all pathogens,and 17.3％ （108/626） of fungal cultures specimens.The fungi positive rate in the second period （13.6％,59/433） was significantly lower than that in the first period （25.4％,49/193,P＜ 0.05）.Conclusion It is essential to reduce the incidence of donor fungal infection by increasing the microbial cultures and antifungal preventive scheme.And it is necessary that the organ procurement organization team enhances the risk awareness of donor-derived fungal infection and improves the aseptic manipulation of organ procurement.Additionally,rinsing and immersing allografts with broad-spectrum antibiotics or diluting povidone-iodine solutions may be a better option for preventing the donor-derived fungal infection during the allograft trim.