肾移植供体来源性感染的调查及干预

Investigation and intervention of donor-derived infection of renal transplantation

目的总结面对潜在供体来源性感染时,对供体选择、受体治疗等方面的经验,提高供体器官利用质量、减少受者术后感染概率并降低受者移植肾丧失甚至死亡的风险。方法本研究以2017年4月至2018年3月间31例供体捐献的59个肾脏及相应受者为研究对象进行回顾性分析。结果31例供体中仅有10例供体的病原学培养结果均为阴性,仅占32%;供体血培养为鲍曼不动杆菌的两位受体,给予舒普深、替加环素抗感染治疗;供体痰培养为鲍曼不动杆菌的两位受体,给予舒普深抗感染治疗;痰培养为白色念珠菌的供体,其受体术后尿培养为白色念珠菌,给予患者氟康唑抗感染治疗;上述受体经过针对性抗感染治疗,均未发生供体来源性感染导致的严重不良事件。结论尽管供体在获取器官前存在感染的现象是相当普遍的,但通过对相应供体针对性、预防性应用足量、足疗程敏感抗生素,严密检测患者感染指标变化,及时调整用药,可以在很大程度上保证受者预后,减少供体来源感染导致的不良事件。

Objective To summarize the experience of donor selection and receptor therapy in the face of potential donor infection,which improves the quality of the use of donor organs,reduces the risk of postoperative infection and the loss of transplant kidney and recipient mortality.Methods This study used a retrospective analysis of 59 kidneys from 31 donors and corresponding recipients from April 2017 to March 2018.Results The pathogenic culture of only 10 donors in 31 donors were totally negative,accounting for only 32%.Two receptors whose donor s blood culture was positive for Acinetobacter baumannii were treated with cefoperazone sulbactam sodium and tigecycline;two receptors whose donor s phlegm culture was positive for Acinetobacter baumannii were treated with cefoperazone sulbactam sodium;for the donor whose phlegm culture was positive for Candida albicans,the responding recipient whose urine culture was positive for the same pathogenic bacteria was treated with fluconazole;none of the above recipients experienced serious adverse events caused by donor-derived infections after targeted anti-infective treatment.Conclusion Although it is quite common for the donor to have an infection before the organ is acquired,we could improve prognosis of the patients and reduce the serious adverse events caused by donor-derived infections through a package of measures,such as target and preventive application of appropriate and prophylactic antibiotics to the corresponding donors,closely detecting changes in infection indicators,and adjusting medications timely.