供肾灌注液培养微生物分布及治疗对策

Distribution and therapy strategy of culture microorganisms of kidney perfusion fluid

目的分析供肾灌注液及移植肾周引流液标本培养微生物分布特点，为指导临床用药提供依据。方法回顾性分析肾移植供者、受者、供肾灌注液及移植。肾周引流液标本培养等临床资料。结果将61例供者的91个供肾灌注液标本及其对应受者的移植肾周引流液标本进行微生物培养，其中48个为来自同一供者的成对供。肾。14个供肾灌注液标本培养结果阳性（15．4％，14／91），培养出17个菌株，其中13个为细菌，4个为真菌；13个细菌菌株中9个（69．2％，9／13）为多重耐药菌株，其中7个细菌菌株存在碳青霉烯类抗生素耐药（7／13），但是供肾灌注液微生物培养阳性未影响受者预后。8例受者移植肾周引流液标本培养结果阳性（8．8％，8／91），5（5／8）个细菌菌株为多重耐药菌株，3（3／8）个细菌菌株对碳青霉烯类抗生素美罗培南、亚胺培南耐药。分析发现供者住院时间长短与培养结果是否阳性无相关性（P〉0．05）。灌注液或引流液培养结果是否阳性与移植术后受者住院天数无相关性（P〉（）．05）。结论供肾灌注液微生物培养阳性供肾可以安全地用于肾移植，常规供肾灌注液微生物培养结合有效的预防感染治疗或抢先治疗策略能够降低受者感染风险。

Objective To analyze the distribution of microorganisms in kidney perfusion fluid and perirenal drainage of the renal allografts, and provide evidence to guide clinical practice. Methods The clinical data from the kidney donors and the recipients, the microbiologic culture results of kidney perfusion fluid and perirenal drainage were retrospectively analyzed. Results Ninety-one kidney perfusion fluid samples and 91 perirenal drainage samples were collected from 61 individual renal allografts, and 48 renal allografts were paired. Fourteen （15. 4%, 14/91） cultured kidney perfusion fluid samples were positive, 17 strains were confirmed including 13 strains of bacteria and 4 strains of fungal, and 9 （69. 2%, 9/13） of bacterial strains were multidrug-resistance with 7 strains resistant to earbapenems, but there was no significant heterogeneity in the outcome of recipients with positive or negative culture results of kidney perfusion fluid samples. Eight （8. 8%, 8/91） perirenal drainage samples from different recipients were positive, 5 of 8 bacterial strains were multidrug-resistance and 3 of them were resistant to carbapenems including meropenem or imipenem. There was no significant correlation between the length of donors＂ hospital stay and the culture results （P〉0. 05）, and there was also no significant correlation between the length of recipients＇ hospital stay after transplantation and the culture results （P〉0. 05）. Conclusion The kidney with positive perfusion fluid microbiologic culture can be transplanted safely using the prophylaxis or preemptive anti-infection therapy.