供体来源碳青霉烯酶类耐药肺炎克雷伯杆菌感染——肝肾移植的差异

The difference between liver and kidney transplantation——Donor derived infection of carbapenemresistant Klebsiella pneumonia

目的探讨目前肝肾移植后碳青霉烯类耐药肺炎克雷伯杆菌(CRKP)感染的治疗。方法回顾性分析上海交通大学医学院附属仁济医院肝脏外科2017年收治的供体来源CRKP感染的肝移植和肾移植受者的临床资料和治疗过程。结果 2017年仁济医院肝脏外科收治明确诊断的肝移植受者供体来源CRKP 1例,经联合抗感染(美罗培南+替加环素+磷霉素)治疗3周后控制感染,顺利转出监护室。收治相应的肾移植受者2例,1例于术后10天出现移植肾周感染,切除移植肾,效果不佳,最终死亡;另1例术后22天出现移植肾周感染,应用碳青霉烯酶抑制剂联合碳青霉烯类抗生素后救治成功。结论就术后早期并发供体来源的CRKP感染而言,肝移植受者发病早,临床表现以脓毒血症为主,相对容易控制;肾移植受者发病晚,临床表现为移植肾局部感染,较难控制,需应用碳青霉烯酶抑制剂联合治疗。

Objective To investigate the treatment of donor derived carbapene-resistant Klebsiella pneumoniae（CRKP）infection after liver and kidney transplantation. Methods The clinical data including treatment processes of the liver transplantation and renal transplantation recipients who infected by carbopenemresistant Klebsiella pneumonia in the Department of Orthopaedics, Renji Hospital, the Affiliated Hospital of Shanghai Jiao Tong University in 2017 were analyzed retrospectively. Results In 2017, a donor derived infection with CRKP was diagnosed definitely in one liver recipient. Though septic shock arisen, the infection was controlled by a combination therapy of antibiotics（ Meropenem ＋ Tigecycline ＋ Fosfomycin）for 3 weeks. There was a pair of renal transplant recipients with grafts from the same donor. 1 case showed infection around the transplanted kidney 10 days after surgery. Although the kidney was removed, the patient died eventually. The other patient who had the similar infection around the transplanted kidney 22 days after surgery, was treated with carbapenase inhibitor combined with carbapenem. This patient recovered quickly. Conclusion In terms of postoperative donor derived CRKP infection,the main presentation was septicopyemia in liver transplant recipients, and was relatively easy to control. Renal transplantation recipients has a relative later onset, which was presented as a local infection of transplanted kidney,and more difficult to control. Additionally a combination of carbapenase inhibitor with carbapenem should be considered..