对器官移植受者实施CRE主动筛查的报告

Active screening of CRE in solid organ transplant recipients

目的探讨实体器官移植科重症监护病房(ICU)内实施耐碳青霉烯类肠杆菌(CRE)主动筛查的人群在执行手卫生等感染防控措施条件下,发生ICU内CRE的定植情况。方法对器官移植ICU的全部患者,在其进入和转出ICU两个时间点,通过肛拭子对其进行CRE的主动筛查。结果共79例患者中,其进入ICU时筛查阳性比例,肝移植受者为10/47,亲体肝移植供肝者为1/1,再入ICU者为3/6,肾移植、胰肾联合移植及非移植手术后患者为0/14。4例患者入ICU时筛查阴性,而转出ICU时筛查呈阳性。筛查检出的CRE中,肺炎克雷伯菌和大肠杆菌是主要菌种。结论肝移植受者发生CRE定植风险较其他腹部实体器官移植受者高,更应注意CRE的防控。

Objective To evaluate the effect of active screening of carbapenem-resistant enterobacteriaceae（CRE） together with infection control measures, such as hand hygiene, on prevention of CRE colonization in intensive care unit（ICU）. Methods The active screening of CRE was carried out when patients were transferred or admitted between August 2017 and October 2017. Results A total number of 79 patients recept active screening, and positive results were found in 10/47 recipients after liver transplant, 1/1 donor, 3/6 patients after readmission and 1/14 patient after Kidney transplantation, combined pancreatokidney transplantation or non-transplantation surgery. 4/79 negative patients were found positive when they were discharged from ICU. The carbapenem-resistant Klebsiella pneumoniae（CRKP） and Escherichia coli are dominant among the colonized CRE. Conclusion The colonization rate of rectal CRE is higher in recipients after liver transplant than others. More attention should be paid to the prevention and control of CRE in these patients.