心脏死亡器官捐献肾移植术后受体医院感染特征及影响因素分析

Characteristics and influencing factors for infections in receptors receiving kidney transplantation from donation of cardiac death

目的分析心脏死亡器官捐献(DCD)肾移植术后发生感染的特点及影响因素。方法回顾性收集医院2016年1-12月63例DCD肾移植手术受体及其供体的临床资料,分析DCD肾移植术后感染特征及影响因素。结果 DCD肾移植术后感染率为38.10%(24/63);感染主要发生在术后30d内(70.59%,24/34);与非感染患者相比,感染患者平均增加术后住院天数31.50d,增加住院费用56840.12元;主要感染部位依次为下呼吸道、泌尿道、血流感染;主要病原菌为耐碳青霉烯类肺炎克雷伯菌、真菌;单因素分析结果显示术后住院时间、出现移植肾排斥、术前预防用药为非碳青霉烯类是DCD肾移植术后患者发生医院感染的相关因素(P<0.05),供体与受体的感染关联无统计学意义,多因素分析结果显示,术后住院时间>60d、术前预防用药为非碳青霉烯类是术后感染的影响因素。结论 DCD肾移植术后感染发生率高,感染发生与住院时间、术前预防用药有关,供体感染状态与受体感染之间的关系缺乏统计学证据支持。

OBJECTIVE To investigate the characteristics and influencing factors for infections after kidney transplantation from donation of cardiac death.METHODS The clinical data were retrospectively collected from 63 cases of receptors and donors who underwent DCD kidney transplantation from Jan 2016 to Dec 2016.The characteristics and influencing factors for the infection after the DCD kidney transplantation were observed.RESULTS The incidence rate of infection was 38.10%（24/63）after the DCD kidney transplantation.The infection mainly occurred within30 days after the surgery（70.59%,24/34）.As compared with the patients without infection,the patients with infection were with an average increase of 31.50 days of hospitalization duration after the surgery and an increase of 56840.12 yuan of hospitalization cost.Lower respiratory tract,urinary tract and bloodstream were the major infection sites.Carbapenemresistant Klebsiella pneumoniae and fungi were dominant among the pathogens.The result of univariate analysis showed that the postoperative hospitalization duration,renal allograft rejection and preoperative antibiotics prophylaxis were the related factors for the nosocomial infections in the patients after the DCD kidney transplantation（P〈0.05）.The infection in the donors was not associated with the infection in the receptors,and there was no significant difference.The result of the multivariate analysis indicated that more than 60 days of postoperative hospitalization duration and preoperative prophylactic use of carbapenems were the influencing factors for the postoperative infections.CONCLUSIONThe incidence rate of infection is high after the DCD kidney transplantation.The infection is associated with the length of hospital stay and preoperative antibiotics prophylaxis.The correlation between the state of infection in the donors and the infection in the receptors lacks the statistical evidence support.