器官保存液病原体与肝移植受者感染关系分析

Relationship between pathogens in organ preservation solution and infection of liver transplant recipients

目的探讨器官保存液病原微生物培养情况及其对肝移植受者术后感染的影响。方法回顾性分析2017年10月至2018年12月在中山大学附属第三医院行肝移植的273例受者临床资料。受者和(或)家属签署知情同意书,符合医学伦理学规定。其中男238例,女35例;年龄16~77岁,中位年龄49岁。对器官保存液和受者移植术后血、尿、痰、腹腔积液等标本行细菌、真菌检测及药物敏感分析,分析器官来源的病原体传播和导致移植受体感染的情况。结果器官保存液病原体培养阳性率45.8%(125/273),常见细菌依次为表皮葡萄球菌20例,人葡萄球菌12例,屎肠球菌11例,鲍曼不动杆菌11例,肺炎克雷伯菌10例。其中鲍曼不动杆菌和肺炎克雷伯菌均对不同抗生素具有耐药性,鲍曼不动杆菌对碳青霉烯类抗生素耐药率高达91%,而肺炎克雷伯杆菌对碳青霉烯类抗生素耐药率也高达30%。肝移植术后出现可能器官来源的病原体传播9例,其中鲍曼不动杆菌5例,屎肠球2例,表皮葡萄球菌2例,肺炎克雷伯菌1例。出现可能器官来源的病原体感染2例,分别为泛耐药的鲍曼不动杆菌和肺炎克雷伯菌。器官来源的病原微生物培养常见阳性部位为腹腔,其次为肺部、血液、腹部伤口。结论器官保存液中微生物复杂多样,多数来源于皮肤或肠道定植菌群。多重耐药菌易导致受体感染并产生不良后果。腹腔是器官来源病原体检出率最高的部位。

Objective To investigate the microbial cultivation of pathogens in organ preservation solution and its impact on the postoperative infection of liver transplant recipients.Methods Clinical data of 273 recipients undergoing liver transplantation in the Third Affiliated Hospital of Sun Yat-sen University from October 2017 to December 2018 were retrospectively analyzed.The informed consents of all recipients and(or)families were obtained and the local ethical committee approval was received.Among them,238 patients were male and 35 female,aged from 16 to 77 years,with a median age of 49 years.Bacterial,fungal detection and drug sensitivity analysis were performed for the organ preservation solution and blood,urine,sputum,ascites of recipients after liver transplantation.The transmission of organ-derived pathogens and the infection of transplant recipients were analyzed.Results The positive rate of pathogen culture in organ preservation solution was 45.8%(125/273).The common bacteria mainly consisted of Staphylococcus epidermidis(n=20),Staphylococcus aureus(n=12),Enterococcus faecalis(n=11),Acinetobacter baumannii(n=11)and Klebsiella pneumoniae(n=10).Acinetobacter baumannii and Klebsiella pneumoniae were resistant to different antibiotics.The resistance rate of Acinetobacter baumannii to carbapenems was 91%,and 30%for Klebsiella pneumoniae to carbapenems.After liver transplantation,potential organ-derived pathogen transmission was observed in 9 recipients,including 5 cases of Acinetobacter baumannii,2 cases of Enterococcus faecalis,2 cases of Staphylococcus epidermidis and 1 case of Klebsiella pneumoniae.2 recipients presented with potential organ-derived pathogen infection,which were pan-drug resistant Acinetobacter baumannii and Klebsiella pneumoniae.The common sites of positive organ-derived pathogens were abdominal cavity,followed by lung,blood and abdominal wounds.Conclusions The pathogens in organ preservation solution are complex and diverse,most of which are derived from skin or intestinal flora.Multi-drug-resistant bacteria are likely to lead to infection of recipients and adverse events.Abdominal cavity is the part with highest detection rate of organ-derived pathogens.