肾移植受者围手术期病原菌分布及耐药性的单中心分析

Single-center analysis of pathogenic bacteria distribution and drug resistance in renal transplantation patients during perioperative period

目的探讨肾移植受者围手术期病原菌分布及对常用抗菌药物的耐药性,为肾移植术后感染的经验性治疗提供参考。方法选取首都医科大学附属北京友谊医院肾移植病区2020年1月1日至2021年6月30日间行死亡捐献肾移植术的251例受者,记录标本送检情况,分析病原菌分布及耐药性,记录可能的供者源性的感染发生率及整体预后。结果围手术期病原菌检出率为12.18%(367/3014)。其中非重复菌株225株,革兰氏阳性菌、革兰氏阴性菌和真菌占比分别为48.89%(110/225),43.11%(97/225)和8.00%(18/225)。检出部位中,灌洗液占比49.78%(112/225),以表皮葡萄球菌和肺炎克雷伯菌为主;引流液占比24.88%(56/225),以恶臭假单胞菌和溶血葡萄球菌为主;尿液占比18.67%(42/225),以屎肠球菌为主;血液占比6.22%(14/225),以表皮葡萄球菌为主。检出的病原菌均呈现不同程度的耐药,屎肠球菌对氨苄西林、万古霉素、利奈唑胺的耐药率分别为93.33%(28/30)、6.45%(2/31)和38.71%(12/31)。肺炎克雷伯菌和鲍曼不动杆菌对碳青霉烯类的耐药率分别为71.43%(20/28)和80.00%(12/15)。可能的供者源性感染发生率为3.59%(9/251)。所有受者无死亡病例。结论肾移植受者围手术期病原菌检出率较高,不同标本类型中病原菌分布有差异,检出的病原菌均呈现不同程度的耐药,应定期分析耐药菌分布特点和原因,依据药敏结果合理使用抗菌药物。

Objective To explore the distribution of pathogenic bacteria during perioperative period of kidney transplantation(KT)patients and examine drug resistance of major clinical pathogens to commonly used antibiotics to provide references for empirical medication of pathogenic bacteria infection after KT.Methods From January 1,2020 to June 30,2021,251 patients undergoing deceased donation KT on kidney transplant ward were selected.Clinical samples were collected and distribution and drug resistance of pathogenic bacteria examined for analyzing the incidence of possible donor-derived infections and predicting prognoses.Results The detection rate of pathogens was 12.18%(367/3014).A total of 225 non-repetitive strains were isolated.Gram-positive bacteria,Gram-negative bacteria and fungi accounted for 48.89%(110/225),43.11%(97/225)and 8.00%(18/225).The proportion of lavage fluid in all isolated bacteria was 49.78%(112/225).And Staphylococcus epidermidis and Klebsiella pneumoniae predominated.Drainage fluid accounted for 24.88%(56/225)and Pseudomonas putida and Staphylococcus haemolyticus predominated.Urine accounted for 18.67%(42/225)with a dominance of Enterococcus faecium;blood accounted for 6.22%(14/225)with a dominance of S.epidermidis.All detected pathogens showed varying degrees of resistance.The resistance rates of E.faecium to ampicillin,vancomycin and linezolid were 93.33%(28/30),6.45%(2/31)and 38.71%(12/31).The resistance rates of K.pneumoniae and Acinetobacter baumannii to carbapenems were 71.43%(20/28)and 80.00%(12/15).The incidence of possible donor-derived infection was 3.59%(9/251)and there was no mortality.Conclusions The detection rate of pathogenic bacteria is high in KT patients during perioperative period.There is a diverse distribution of isolates of different specimen types and all detected pathogens show varying degrees of drug resistance.Clinicians should regularly analyze the distribution characteristics and causes of drug-resistant bacteria.And antibiotics should be optimized according to the results of drug sensitivity.