器官移植供者来源感染防控效果研究

Prevention and control effect of donor-derived infections in solid organ transplant recipients

目的探讨供者来源感染(Donor derived infection,DDI)防控干预措施对降低实体器官移植患者医院感染发生率、耐碳青霉烯肺炎克雷伯菌(Carbapenem-Resistant Klebsiella Pneumoniae,CRKP)感染率以及DDI引起的CRKP感染率的效果。方法采用回顾性队列研究,选择在上海长海医院接受器官移植的所有患者为研究对象,2016年6月-2017年12月收集的患者586例为对照组,实施常规医院感染防控措施,2018年1月-2019年2月收集的患者289例为干预组,分别从供者感染状态评估分层后决定器官取舍、供者维护期间的感染防控及接受高风险供者器官移植后受者的防控三个方面实施DDI防控干预措施。观察对比干预前后实体器官移植患者医院感染发生率、医院感染患者中CRKP感染占比、由DDI引起的CRKP感染占比及CRKP感染患者病死率。结果干预组患者医院感染发生率为6.23%(18/289),低于对照组的9.22%(54/586)(P=0.131);干预组CRKP感染率为0.35%(1/289),低于对照组的1.71%(10/586)(P=0.169);干预组医院感染患者中CRKP感染占5.56%(1/18),低于对照组的18.52%(10/54)(P=0.344);干预组由DDI引起的CRKP感染百分比为0.00%,低于对照组的80.00%(P=0.273);干预组CRKP感染患者病死率为0.00%,低于对照组的40.00%(P>0.999),差异均无统计学意义。结论采取DDI防控干预措施能有效降低实体器官移植患者医院感染发生率、CRKP感染率、医院感染患者中CRKP感染占比,特别是由DDI引起的CRKP感染以及CRKP感染患者病死率。

OBJECTIVE To investigate the effect of the prevention and control intervention of donor-derived infections(DDIs)in reducing the incidence of nosocomial infection,carbapenem-resistant Klebsiella pneumoniae(CRKP)infections,and CRKP infection rates caused by DDIs in solid organ transplant recipients.METHODS A retrospective cohort study was used to select all patients who underwent organ transplantation at Shanghai Changhai Hospital as the research subjects.From Jun.2016 to Dec.2017,586 patients were collected as the control group,and conventional hospital infection prevention and control measures were implemented.From Jan.2018 to Feb.2019,289 patients were selected as intervention group.DDI prevention and control interventions were implemented from the three aspects including donor infection status assessment and decision-making organ selection,infection prevention and control during donor maintenance,and prevention and control of recipients after receiving high-risk donor organ transplantation.The incidence of nosocomial infection in patients with solid organ transplantation before and after intervention,the proportion of CRKP infection in nosocomial infection patients,the percentage of CRKP infection caused by DDI,and the mortality of CRKP infection patients were observed and compared.RESULTS The incidence of nosocomial infection was 6.23%(18/289)in the intervention group,lower than that in control group[9.22%(54/586)](P=0.131).CRKP infection rate was 0.35%(1/289)in the intervention group,lower than that in control group[1.71%(10/586)](P=0.169).The proportion of CRKP infection in nosocomial infections was 5.56%(1/18)in the intervention group,lower than that in control group[18.52%(10/54)](P=0.344).The proportion of CRKP infection caused by DDI was 0%in the intervention group,lower than that in control group(80.00%)(P=0.273).The mortality of patients due to CRKP infection was 0%in the intervention group,lower than that in control group(40.0%)(P>0.999).CONCLUSION The DDI prevention and control interventions can effectively reduce the incidence of nosocomial infections,CRKP infection rate,the proportion of CRKP infection in patients with solid organ transplants,especially CRKP infections caused by DDI mortality in CRKP infected patients.