器官保存液微生物培养对于移植术后感染的预警作用:单中心回顾性病例对照研究

The forewarning function of microbial culture in organ preservation solution on infection after transplantation:a single center,retrospective study

目的探讨保存液(preservation solution,PS)的微生物污染是否与供者来源性感染(donor derived infection,DDI)相关。方法回顾性分析海军军医大学第一附属医院器官移植中心于2016年3月至2022年9月收治的624例肾移植受者的临床资料,分析器官PS微生物学培养结果,根据培养结果分为阳性和阴性两组。分析器官PS中病原菌的分布情况,比较两组受者术后感染情况。结果624例器官PS中有349例培养结果阳性,阳性率为55.93%,其中230例(65.90%)分离出的病原菌为单一菌种,119例(34.10%)分离出≥2种的病原菌。共分离菌株497株,居前3位的是凝固酶阴性葡萄球菌(83株,16.70%)、肠球菌属(61株,12.27%)和肺炎克雷伯菌(53株,10.66%)。阳性组患者移植后感染率(26.36%,92/349)高于阴性组(17.82%,49/275),差异有统计学意义(P<0.05)。45例受者出现可能供者来源性感染(probable donor-derived infections,p-DDIs),其中25例(55.56%)与泛耐药革兰氏阴性菌(multidrug-resistant gram-negative bacteria,MDR GNB)有关,且相较于其他病原菌更可能引发移植后严重感染事件(P<0.05)。结论器官PS易受感染,PS污染是受者术后感染危险因素之一,建议对器官PS常规进行培养。若PS培养结果存在MDR GNB,建议采取精准有效的抗感染治疗。

Objective To determine whether microbial contamination of preservation solution(PS)is associated with donor derived infection(DDI).Methods The clinical data of 624 renal transplant recipients admitted at the Organ Transplantation Center of the First Affiliated Hospital of Naval Medical University from March 2016 to September 2022 were retrospectively analyzed.Recipients were divided into positive group and negative group according to the culture results of PS.The distribution of pathogenic bacteria in organ PS was analyzed and the infection events after transplantation between two groups were compared.Results Among 624 organ PS,349 cases(55.93%)were PS culture positive,single pathogen was found in 230(65.90%)cases,and 119(34.10%)cases were found to have two kinds of pathogens.A total of 497 strains of pathogens were isolated,and the top three were coagulase negative staphylococcus(n=83,16.70%),Enterobacter species(n=61,12.27%)and Klebsiela pneumoniae(n=53,10.66%).Infection rate after transplant in positive group was higher than that in negative group〔26.36%(92/349)vs.17.82%(49/275)〕.Statistical significance was noted between two groups(P<0.05).A total number of 45 recipients were infected with probable donor-derived infections(p-DDIs),and 25(55.56%)recipients of which were infected with multidrug-resistant gram-negative bacteria(MDR GNB).MDR GNB may cause severe infection-related events(P<0.05).Conclusion Contamination of the PS is common in transplantation,it is the risk factor for postoperative infection of recipients.Organ PS should be cultured routinely.If MDR GNB are positive in PS culture,it is recommended to take specific and effective antibacterial treatment.