肾脏移植术后感染患者病原菌分布及耐药性分析

Analysis of pathogen distribution and drug resistance in patients infected after renal transplantation

目的探讨慢性肾衰竭患者肾脏移植术后感染病原菌的分布及常用抗菌药的耐药情况。方法采用回顾性研究方法,对河南省部分三甲医院2017年1月—2019年5月慢性肾衰竭肾脏移植术后感染患者送检的病原学标本进行细菌种类鉴定和耐药性分析。结果分离出病原菌147株,其中以革兰阴性菌为首位,占68.71%,革兰阳性菌和真菌的构成比依次为14.29%、17.01%。感染病原菌中检出率居前5位的依次是肺炎克雷伯菌、大肠埃希菌、嗜麦芽寡养单胞菌、鲍曼不动杆菌和白念珠菌,感染部位以呼吸道(42.86%)、泌尿道(16.33%)和血液系统(11.56%)为主。共检出多重耐药菌(MDRO)35株,占23.81%,其中以肺炎克雷伯菌(12株)、大肠埃希菌(5株)和鲍曼不动杆菌(5株)为主。未检出耐万古霉素和利奈唑胺、替考拉宁革兰阳性球菌。结论病原菌以革兰阴性杆菌为主,且多重耐药菌株检出率较高,应加强移植术后患者感染的预防和控制。

Objective To investigate the distribution of pathogenic bacteria and their resistance to common antimicrobial agents in patients with chronic renal failure after renal transplantation. Methods A retrospective study was conducted to analyze identification of bacterial species and drug resistance on specimens of chronic renal failure patients with infections after renal transplantation in some third-grade class-A hospitals in Henan province from Jan. 2017 to May 2019. Results 147 strains of pathogenic bacteria were isolated from infected patients after renal transplantation, including Gram-negative bacteria(68.71%), Gram-positive bacteria,(14.29%), and fungi(17.01%). The top five pathogens were Klebsiella pneumoniae, Escherichia coli, Stenotrophomonas maltophilia, Acinetobacter baumannii, and Candida albicans. The main infection sites were respiratory tract(42.86%), urinary tract(16.33%), and blood system(11.56%). 35 Multidrug-Resistant Organism(MDRO) strains were detected totally, accounting for 23.81%. Most were Klebsiella pneumoniae(12 strains), Escherichia coli(5 strains), and Acinetobacter baumannii(5 strains). The Gram-positive coccus resistant to vancomycin, teicoplanin, or linezolid were not detected. Conclusion The pathogens causing infections were dominately Gram-negative bacilli, and the detection rates of multiple drugresistant strains were high. It is necessary to strengthen the prevention and control of infections in patients after renal transplantation.