145例肝移植患者术后医院感染病原菌的分布及耐药性分析

Analysis of distribution and drug resistance of 145 pathogenic bacteria causing postoperative infections in liver transplantation patients

目的回顾分析肝移植患者术后细菌感染病原菌的分离部位、种类及耐药性,为合理有效的防治术后感染提供依据。方法收集医院2014年1月-2016年12月肝移植病区患者术后送检标本分离出的182株病原菌的分布及耐药性,采用法国生物梅里埃公司API鉴定系统进行细菌鉴定,采用E-test法进行药敏试验。结果 145例肝移植患者中,术后发生医院感染率为73.10%;182株病原菌,主要分离自呼吸道和胆道分泌物,以肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌和屎肠球菌为主;革兰阴性菌多数呈高耐药性,其中肺炎克雷伯菌和大肠埃希菌对哌拉西林、头孢唑啉、头孢噻肟和氨苄西林/舒巴坦的耐药率>50%;屎肠球菌对常用抗菌药物普遍耐药。结论肝移植患者术后发生医院感染的风险较高,以呼吸道和胆道感染最常见,病原菌以革兰阴性菌为主,且多为多重耐药菌,合理选用抗菌药物治疗术后医院感染非常重要。

Objective To retrospectively analyze the types,distribution and drug resistance of pathogenic bacteria causing infections in patients after liver transplantation,so as to provide basis for rational and effective prevention of infection. Methods One hundred and eighty two strains of pathogenic bacteria were isolated from the clinical specimens obtained from the patients who underwent liver transplantation in the hospital during Jan. 2014-Dec. 2016 to explore the distribution and drug resistance. The bacteria were identified by Bio Merieux API system and susceptibility test was performed by E-test method. Results Among the145 patients,most of them were infected after the liver transplantation operation at hospital,with the infection rate of 73. 10%.Totally 182 bacteria strains were isolated,mainly from respiratory tract and biliary tract. Most of the strains were Klebsiella pneumonia,Escherichia coli,Pseudomonas aeruginosa,and Enterococcus faecium. Most Gram-negative bacteria had high antibiotic resistance,among which the resistance rates of Klebsiella pneumonia and Escherichia coli to pieracillin,cefazolin,cefotaxime and ampicillin sulbactam were more than 50%,and Enterococcus faecium also showed a certain resistance to commonly used antibiotics. Conclusion There was a high risk of multiple infections after liver transplantation at hospital,usually occurs at respiratory tract and biliary tract system. The main pathogen is Gram-negative bacteria which showed multi-drug resistance.Therefore the rational use of antibiotics is very important at controlling postoperative infections at hospital.