实体器官移植受者耐碳青霉烯类肠杆菌科细菌定植情况观察

Colonization of carbapenem-resistant Enterobacteriaceae in solid organ transplant recipients

目的观察实体器官移植受者的耐碳青霉烯类肠杆菌科细菌(CRE)定植情况,为器官移植受者CRE的预防和治疗提供策略。方法器官移植受者523例,记为研究组,其中成人肝移植受者172例、小儿肝移植受者157例、肾移植受者177例、胰肾联合移植受者17例。选取小儿亲体肝移植供者62例,作为对照组。所有患者转入、转出ICU时分别留取肛拭子,使用Vitek 2 Compact全自动微生物鉴定及药敏分析仪进行细菌鉴定。肛拭子筛查CRE阳性的患者,视为CRE定植者。观察并比较两组CRE定植情况(CRE检出率、CRE定植阳性率),观察患者转入/转出ICU时CRE定植情况。留取CRE定植者血液、无菌体液、痰液及尿液进行细菌培养和菌种鉴定,CRE培养阳性者视为CRE感染者,观察两组患者中因CRE感染导致死亡的患者情况。结果两组患者共行肛拭子检测1420例次,其中CRE阳性菌株134株,占比9.4%,包括肺炎克雷伯菌104株、大肠埃希菌29株、阴沟肠杆菌1株。研究组CRE检出率、CRE定植阳性率高于对照组(P<0.05)。小儿肝移植受者CRE定植阳性率高于其他类型器官移植受者(P均<0.05)。37例患者转入ICU时无CRE定植,转出ICU时存在CRE定植;24例患者转入ICU时存在CRE定植,转出ICU时无CRE定植;21例患者转入和转出ICU时均有CRE定植。研究组因CRE感染导致死亡患者8例,其中小儿肝移植受者7例、成人肝移植受者1例,对照组因CRE感染导致死亡患者0例。结论实体器官移植受者CRE检出率、CRE定植阳性率升高,其中小儿肝移植受者CRE定植阳性率最高,可能会增加小儿肝移植受者因CRE感染导致的死亡率。

Objective To investigate the colonization characteristics of carbapenem-resistant Enterobacteriaceae(CRE)in patients undergoing solid organ transplantation,and to provide strategies for prevention and treatment.Methods There were 523 recipients of organ transplantation in the study group,including 172 adult liver transplantation recipients,157 pediatric liver transplantation recipients,177 kidney transplant recipients,and 17 pancreas kidney transplantation recipients.Sixty-two donors of living related liver transplantation(LRLT)were selected as the control group.The anal swabs were taken from all patients when they were transferred to and out of ICU,and bacteria were identified by VITEK 2 compact automatic microbial identification and drug sensitivity analyzer.The CRE positive patients who were detected by anal swabs were regarded as CRE colonizers.CRE colonization was compared between the two groups(CRE detection rate and CRE positive rate),and CRE colonization was observed when patients were transferred into or out of ICU.Blood,aseptic body fluid,sputum and urine of CRE colonizers were collected for bacterial culture and bacteria identification.CRE culture positive patients were regarded as CRE infected patients.The patients who died of CRE infection in the two groups were observed.Results A total of 1420 cases of anal swab were detected in the two groups;there were 134 CRE positive strains(9.4%),including 104 strains of Klebsiella pneumoniae,29 strains of Escherichia coli,and 1 strain of Enterobacter cloacae.The CRE detection rate and CRE colonization positive rate in the study group were higher than those in the control group(P<0.05).The positive rate of CRE colonization in pediatric liver transplantation recipients was higher than that in other types of organ transplantation recipients(all P<0.05).Thirty-seven patients had no CRE colonization when they were transferred to ICU,but there were CRE colonization when they were transferred out of ICU;24 patients had CRE colonization when they were transferred into ICU,but no CRE colonization when they were transferred out of ICU;21 patients had CRE colonization when they were transferred into and out of ICU.In the study group,8 patients died of CRE infection,including 7 pediatric liver transplantation recipients and 1 adult liver transplantation recipients,while no one in the control group died of CRE infection.Conclusion CRE detection rate and CRE colonization positive rate increase in solid organ transplantation recipients,and CRE colonization positive rate in pediatric liver transplantation recipients is the highest,which may increase the mortality of pediatric liver transplantation recipients caused by CRE infection..