器官移植患者院内感染病原体分布及其药敏分析

Distribution and drug susceptibility of pathogens causing nosocomial infection in organ transplant patients

目的分析器官移植患者院内感染病原体的分布及耐药性,为器官移植患者院内感染的治疗提供依据。方法收集2016年1月至2017年12月海军军医大学(第二军医大学)长海医院149例器官移植患者的临床样本。使用VITEK 2 Compact全自动微生物分析仪或Microflex基质辅助激光解析飞行时间质谱仪进行细菌鉴定。使用VITEK 2 Compact全自动微生物分析仪进行细菌药敏试验,使用ATB Fungus 3药敏试剂盒进行真菌药敏试验。结果器官移植患者感染的病原体主要来源于冲洗液样本(42.3%,101/239)。149例患者中共分离出239株病原菌,其中革兰阴性菌135株(56.5%)、革兰阳性菌77株(32.2%)、真菌27株(11.3%)。革兰阴性菌中肺炎克雷伯菌的检出率最高(13.8%,33/239),且其对哌拉西林等常见抗菌药物的耐药率普遍偏高(耐药率均>50.0%),呈多重耐药趋势;大肠埃希菌对碳青霉烯类药物的敏感性高(耐药率均<5.0%);鲍曼不动杆菌对碳青霉烯类药物的耐药率均高达81.0%。革兰阳性菌中肠球菌对青霉素、氨苄西林等常见抗菌药的耐药率为40.0%~77.2%,但未发现其对利奈唑胺及万古霉素耐药。真菌对常用抗真菌药物的敏感率均高于80.0%,其对伏立康唑的敏感性最高(96.3%)。结论器官移植患者院内感染病原菌主要为革兰阴性菌,肺炎克雷伯菌为主要致病菌,且呈现多重耐药趋势。革兰阳性菌对利奈唑胺及万古霉素敏感。真菌对常用抗真菌药物的敏感性较好。

Objective To investigate the distribution and drug susceptibility profile of pathogens causing nosocomial infection in organ transplant patients, so as to provide a basis for clinical diagnosis and treatment. Methods The clinical samples were collected from 149 organ transplant patients in Changhai Hospital of Navy Medical University（Second Military Medical University） between Jan. 2016 and Dec. 2017. The isolates were identified using VITEK 2 Compact automatic microorganism analyzer system or Microflex matrix-assisted laser desorption ionization-time of flight mass spectrometry. The susceptibility test for bacteria was carried out by VITEK 2 Compact automatic microorganism analyzer system, and the susceptibility test for fungus was carried out by ATB Fungus 3 susceptibility kit. Results Most pathogenic specimens were derived from flushing fluid samples（42.3%, 101/239）. A total of 239 strains of pathogens were isolated from 149 patients, including 135（56.5%） of Gram-negative pathogens, 77（32.2%） of Gram-positive pathogens, and 27（11.3%） of fungi. Klebsiella pneumoniae was the most found Gram-negative pathogens（13.8%, 33/239）, and its resistance to common antibiotics, such as piperacillin, was generally high with the resistance incidence being more than 50.0% and it had a tendency of multi-drug resistance. Escherichia coli had high sensitivity to carbapenems, with incidence of drug resistance being less than 5.0%. Acinetobacter baumannii had high resistance to carbapenems, with incidence of drug resistance being 81.0%. Among Gram-positive pathogens, Enterococcus had 40.0%-77.2% resistance incidence to penicillin and ampicillin, but was sensitive to linezolid and vancomycin. The sensitivity of fungi for most antifungal agents was higher than 80.0%, especially for voriconazole（96.3%）. Conclusion Gram-negative pathogens are the primary pathogens causing nosocomial infection in organ transplant patients. Klebsiella pneumoniae is the main pathogen and has a tendency of multi-drug resistance. Grampositive pathogens are susceptible to linezolid and vancomycin. Fungi are susceptible to commonly used antifungal agents.