器官捐献供者多重耐药菌感染对移植受者的影响

Effect of the donors with multi-drug resistant bacteria infection on the recipients of organ transplantation

目的分析携带多重耐药菌器官捐献供者感染状态对移植受者的影响。方法回顾性分析进行器官捐献且携带多重耐药菌的供者以及对应肝、肾移植受者的相关临床资料,探讨应用此类器官的安全性及相应的干预措施。结果 71例携带多重耐药菌供者中,分离菌株依次为耐碳青霉烯类鲍曼不动杆菌(49.3%)、耐碳青霉烯类绿脓杆菌(22.5%)、耐碳青霉烯类肠杆菌(19.7%)、耐甲氧西林金黄色葡萄球菌(7.0%)及耐万古霉素肠球菌(1.4%);分离部位依次为痰(59.2%)、器官保存液(26.8%)、尿(11.3%)、血(7.0%)、深静脉导管尖端(2.8%)。共随访移植受者198例;其中,83例受者(41.9%)的移植器官可能有供体细菌累及。术后共发生供者来源性感染2例,均为细菌可能累及捐献器官的肝移植受者,术后经过3周以上抗感染治疗后均治愈。结论当供者分离出多重耐药菌时,如无明确累及捐献器官的证据时,应用此类器官是安全、可靠的;而对于可能有细菌累及的捐献器官,并非一定是捐献的绝对禁忌证,仔细评估感染风险和适时的抢先治疗可以在最大化应用器官的同时保证受者的安全性。

Objective To analyze the effect of the donors with multi-drug resistant bacteria infection on the recipients of organ transplantation.Methods The clinical data of the donors with multi-drug resistant bacteria infection and the corresponding liver and kidney transplantation recipients were retrospectively analyzed.The safety of using such organs and the corresponding intervention measures were discussed.Results In 71 donors with multi-drug resistant bacteria infection, the isolated bacterial strains were in an order of carbapenem-resistant Acinetobacter baumannii(49.3%),carbapenem-resistant Pseudomonas aeruginosa(22.5%),carbapenem-resistant Enterobacterium(19.7%),methicillin-resistant Staphylococcus aureus(7.0%) and vancomycin-resistant Enterococcus(1.4%).The sites from where the bacterial strains were isolated were in an order of sputum(59.2%),organ preservation fluid(26.8%),urine(11.3%),blood(7.0%) and deep vein catheter tip(2.8%).A total of 198 transplant recipients was followed up, among whom 83 cases(41.9%) were likely to be involved with donor bacteria.Two cases of donor-derived infection occurred after the operation and were cured with anti-infective therapy for more than 3 weeks, who were the recipients underwent liver transplantation and might have bacteria infection of the transplanted organs.Conclusion When multi-drug resistant bacteria are isolated from the donors, the use of those organs is safe and reliable if there is no evidence of bacteria infection involvement of the transplanted organs.It is not an absolute contraindication for the donation of the organs in the dornor with multi-drug resistant bacteria infection and the careful assessment of infection risk and timely preemptive treatment could make a maximizing use of the organs while the safety of the recipient is ensured.