供者来源性感染对肾移植受者预后的影响

Effect of donor-derived infection on clinical prognosis of kidney transplant recipients

目的探讨供者来源性感染(DDI)对肾移植受者预后的影响。方法回顾性分析82例公民逝世后器官捐献供者及其148例肾移植受者的临床资料。根据供肾灌洗液培养结果,将受者分为供肾灌洗液培养阳性组(阳性组,92例)和供肾灌洗液培养阴性组(阴性组,56例),根据受者是否发生DDI,分为DDI组(19例)和未发生DDI组(129例)。分析供肾灌洗液培养阳性菌株分布及构成比,总结受者术后感染情况及其他并发症发生情况,比较发生DDI组与未发生DDI组受者围手术期情况,分析DDI受者的治疗及预后情况。结果148例肾移植受者中,92例供肾灌洗液培养阳性,共分离出病原菌131株,其中革兰阳性球菌占41.2%(54/131),革兰阴性杆菌占48.9%(64/131),真菌占9.9%(13/131)。148例受者中52例发生感染,其中阳性组有45%(41/92)的受者发生感染,阴性组有20%(11/56)的受者发生感染,差异有统计学意义(P=0.002)。52例感染受者最常见的感染部位为手术部位,其次为泌尿系统。共有19例受者发生DDI,发生率为12.8%,病死率为16%,与未发生DDI组受者比较,DDI组受者移植物丢失率和病死率更高、术后住院时间更长,差异均有统计学意义(均为P<0.05)。8例发生耐碳青霉烯类肺炎克雷伯菌(CRKP)传播感染受者应用替加环素和(或)多黏菌素、碳青霉烯类药物治疗后有3例死亡,3例行移植肾切除;另外8例发生CRKP传播感染受者中,2例单独应用头孢他啶-阿维巴坦(CAZ-AVI),3例应用CAZ-AVI联合碳青霉烯类药物,3例先应用替加环素联合碳青霉烯类药物,而后应用CAZ-AVI进行挽救性治疗,经过治疗后受者均长期存活。结论DDI可导致严重的并发症,早期针对性抗菌治疗有着积极作用。

Objective To evaluate the effect of donor-derived infection(DDI)on clinical prognosis of kidney transplant recipients.Methods Clinical data of 82 donors from donation after citizen’s death and 148 kidney transplant recipients were retrospectively analyzed.According to the culture results of the lavage fluid of donor kidney,all recipients were divided into the lavage fluid culture of donor kidney positive group(positive group,n=92)and lavage fluid culture of donor kidney negative group(negative group,n=56).All recipients were assigned into the DDI group(n=19)and non-DDI group(n=129)according to whether they developed DDI or not.The distribution and composition ratio of positive strains in the lavage fluid of donor kidney were analyzed.The incidence of postoperative infection and other complications was assessed in the recipients.Perioperative conditions of the recipients were statistically compared between the DDI and non-DDI groups.The treatment efficacy and clinical prognosis of DDI recipients were evaluated.Results Among 148 recipients,92 obtained positive culture results in the lavage fluid of donor kidney.A total of 131 pathogenic strains were isolated,including 41.2%(54/131)of Gram-positive cocci,48.9%(64/131)of Gram-negative bacilli and 9.9%(13/131)of fungi.Among 148 recipients,52 cases were infected.And 45%(41/92)and 20%(11/56)of the recipients were infected in the positive and negative group,respectively.Statistical significance was noted between two groups(P=0.002).Surgical site was the most common infection site in 52 infected recipients,followed by the urinary system.Nineteen recipients developed DDI with an incidence rate of 12.8%and fatality of 16%.Compared with the non-DDI recipients,DDI recipients had significantly higher graft loss rate and fatality,and longer postoperative hospital stay(all P<0.05).Eight cases presented with carbapenem-resistant Klebsiella pneumoniae(CRKP)infection,after treatment with tigecycline and/or polymyxin and carbapenems,3 cases died,and 3 underwent kidney graft resection.In the other 8 recipients with CRKP infection,2 cases were treated with ceftazidime-avibactam(CAZ-AVI)alone,3 treated with CAZ-AVI combined with carbapenems,and 3 initially treated with tigecycline combined with carbapenems followed by CAZ-AVI for salvage treatment.After corresponding treatment,the recipients achieved long-term survival.Conclusions DDI may lead to severe complications,while early specific antibacterial treatment plays a positive role.