肝移植术后供体来源耐碳青霉烯类肺炎克雷伯菌感染治疗分析

Analysis of treatment of carbapenem-resistant Klebsiella pneumoniae infection from donors after liver transplantation

目的探讨肝移植供体来源耐碳青霉烯类肺炎克雷伯菌(carbapene-resistant Klebsiella pneumoniae,CRKP)感染的临床特点,总结临床治疗经验。方法回顾性分析河北医科大学第三医院肝胆外科收治的3例供体来源CRKP感染肝移植受者的临床资料和治疗过程。结果3例受者术后痰、引流液或血培养证实为供体来源的CRKP感染,先后联合头孢他啶-阿维巴坦和碳青霉烯类药物抗感染治疗,其中1例移植术后出现腹腔感染,行腹腔脓肿清除术后使用头孢他啶-阿维巴坦标准剂量(3.75 g/d),感染控制效果不佳,最终死亡。1例使用标准剂量,术后3周出现移植肝动脉吻合口破裂出血,行2次手术后使用高剂量(7.5 g/d),受者及移植肝存活,1例使用高剂量(7.5 g/d)治疗4周后感染控制,痰培养及血培养转阴,受者及移植肝存活。结论供体来源CRKP感染明显增加肝移植患者病死率,早期应用头孢他啶-阿维巴坦联合碳青霉烯类药物联合抗感染治疗效果好,增加头孢他啶-阿维巴坦剂量可提高疗效,且未见明显不良反应。

Objective To investigate the clinical features of donor-derived drug-resistant Klebsiella pneumoniae infection and to summarize the experience of clinical treatment after liver transplantation.Methods Retrospective analysis was performed based on clinical data and the diagnosis and treatment of three live transplant recipients with donor-derived carbapene-resistant Klebsiella pneumoniae(CRKP)infection in Department of Hepatobiliary Surgery,the Third Hospital of Hebei Medical University.Results Three recipients with donorderived CRKP infection were confirmed by bacterial culture and were treated with anti-infection therapy(ceftazidineavibactam combined with carbapenems),and one of them developed abdominal infection after transplantation without anti-infection therapy.After removal of abdominal abscess,ceftazidine-avibactam standard dose(3.75 g/d)was used to this recipient.The infection was not well controlled,and the patient eventually died.Standard measurement was used in another case,and bleeding occurred at the anastomotic site of hepatic artery 3 weeks after the operation.After two operations,high dose treatment(7.5 g/d)was used,the recipient and the transplanted liver survived.High doses treatment(7.5 g/d)was given to the third patient,the infection was control 4 weeks after treatment,sputum culture and blood culture were negative,the recipient and graft survived.Conclusion The infection of donor CRKP significantly increases the mortality of liver transplantation patients.The early application of ceftadieneavibatan combined with carbapenems combined with anti-infection treatment has a good effect,and increasing the dose of ceftadiene-avibatan can improve the curative effect,without any obvious adverse reactions.