肾移植与骨髓移植后感染的病原学研究及耐药性分析

Etiological study and drug resistance analysis of infection after kidney transplantation and bone marrow transplantation

目的探讨肾移植与骨髓移植患者感染的特征,为临床抗菌药物的选择提供依据。方法收集2013年1月~2016年12月因感染入住我院的79例肾移植与66例骨髓移植患者的病历资料,分析并比较肾移植与骨髓移植患者的病原菌类型及对相应抗菌药物的耐药性。结果肾移植患者的病原菌(下称肾移植组)以大肠埃希菌、真菌、解脲支原体为主,骨髓移植患者的病原菌(下称骨髓移植组)以大肠埃希菌、屎肠球菌、肺炎克雷伯杆菌为主。肾移植与骨髓移植患者标本中分离的真菌与解脲支原体对相应的抗菌药物耐药率较低,分离的细菌菌株对相应抗菌药物的耐药率较高。骨髓移植组的革兰阳性菌对氨苄西林与复方新诺明的耐药率显著高于肾移植组的革兰阳性菌(P<0.05),对其余抗菌药物的耐药率无显著性差异(P>0.05);骨髓移植组的革兰阴性菌对复方新诺明的耐药率显著高于肾移植组的革兰阴性菌(P<0.05),对其余抗菌药物的耐药率无显著性差异(P>0.05)。结论肾移植患者与骨髓移植患者感染的病原菌分布有所不同,两组病原菌的耐药情况相似。

Objective To investigate the characteristics of infection in renal transplantation and bone marrow transplan- tation, and to provide the basis for the selection of clinical antibiotics. Methods The data of 79 patients with kidney transplantation and 66 patients with bone marrow transplantation admitted in our hospital due to infection from January 2013 to December 2016 were collected. The pathogen types of renal transplantation and bone marrow transplantation and the drug resistance to the corresponding antimicrobial agents were analyzed and compared. Results Pathogens of renal transplant recipients（hereinafter referred as kidney transplantation group） were mainly Escherichia coli, fungi and Ureaplasma urealyticum. Pathogens of bone marrow transplant recipients（bone marrow transplantation group） were mainly Escherichia coli, Enterococcus faecium, Klebsiella pneumoniae. The resistance rates of fungi and Ureaplasma urealyticum isolated in kidney transplant and bone marrow transplant patients to the corresponding antimicrobial were low, while the resistance rate of separated bacterial strains to the corresponding antimicrobial was high. The resistant rate of gram-positive bacteria to ampicillin and cotrimoxazole in bone marrow transplantation group was significantly higher than that in kidney transplantation group（P〈0.05）, and there was no significant difference in resistance rate of gram-positive bacteria to other antibiotics（P〉0.05）. The resistance rate of gram-negative bacteria in bone marrow trans- plantation group was significantly higher than that in kidney transplantation group（P〈0.05）, and there was no significant difference in resistance rate of gram-negative bacteria to other antibiotics（P〉0.05）. Conclusion The distribution of pathogens is different between kidney transplant recipients and bone marrow transplant patients. The drug resistance of the two groups is similar.