郑州市某三甲医院168例肾脏移植术后感染患者病原菌分布和耐药性及危险因素分析

Distribution of pathogenic bacteria,drug resistance and risk factors of168 patients infected after kidney transplantation in a tertiary hospital in Zhengzhou

目的 分析肾脏移植患者术后感染的病原菌分布、耐药性及危险因素,为临床诊治提供依据。方法 选取2019年3月至2022年3月某院收治的168例肾脏移植患者作为研究对象,根据术后有无感染分为感染组(n=51)和非感染组(n=117),进行病原菌培养及药敏试验,并收集两组患者的一般资料,采用Logistic回归分析影响肾脏移植后感染的危险因素。结果 168例肾脏移植患者中感染率为30.36%,其中呼吸系统感染占43.14%,泌尿系统感染占33.33%,消化系统感染占15.68%,血液系统感染占7.84%。51例肾脏移植术后感染患者共培养出病原菌68株,其中革兰阴性菌占50.00%,革兰阳性菌占44.12%,真菌占5.88%,革兰阴性菌以铜绿假单细胞菌、大肠埃希菌、肺炎克雷伯菌最为多见,分别占17.65%、14.71%、8.82%;革兰阳性菌以表皮葡萄球菌、金黄色葡萄球菌最为多见,分别占16.18%、13.24%。革兰阴性菌对左氧氟沙星、头孢吡肟、头孢噻肟、头孢他啶、头孢唑林、哌拉西林/他唑巴坦、氨苄西林/舒巴坦、阿莫西林/克拉维酸的耐药率较高;革兰阳性菌对红霉素、克林霉素、复方新诺明、左氧氟沙星、头孢吡肟的耐药率较高。单因素分析显示,贫血、住院时间≥30 d、血红蛋白<90 g/L、白蛋白<30 g/L、留置尿管时间≥4 d是肾脏移植后感染的因素(P<0.05)。logistic多因素回归分析显示,贫血(OR=1.419,95%CI:1.146~1.757)、住院时间≥30 d(OR=1.406,95%CI:1.152~1.718)、血红蛋白<90 g/L(OR=1.426,95%CI:1.136~1.790)、白蛋白<30 g/L(OR=1.420,95%CI:1.141~1.769)、留置尿管时间≥4 d(OR=1.433,95%CI:1.162~1.768)是肾脏移植后感染发生的独立危险因素。结论 肾脏移植后感染率较高,易感部位为呼吸系统,主要病原菌为革兰阴性菌,多数细菌对抗生素具有耐药性,临床应加强病原菌监测,并结合药敏试验合理选用抗生素;贫血、住院时间≥30 d、血红蛋白<90 g/L、白蛋白<30 g/L、留置尿管时间≥4 d是肾脏移植后感染发生的独立危险因素,临床应对危险因素采取针对性干预,以降低感染率。

Objective To analyze the pathogenic bacteria distribution, drug resistance and risk factors in patients with infection after renal transplantation, so as to provide a basis for clinical diagnosis and treatment. Methods A total of 168 patients who had undergone renal transplantation in the hospital between March 2019 and March 2022 were selected as the research subjects.They were divided into infection group(n=51) and non-infection group(n=117) according to the presence or absence of infection after operation. Pathogenic bacteria culture and drug susceptibility test were performed. General data of the two groups were collected to screen the influencing factors of infection after renal transplantation by logistic regression analysis. Results Of the168 study subjects, the infection rate was 30.36%. The proportions of respiratory system infection, urinary system infection,digestive system infection and blood system infection were 43.14%, 33.33%, 15.68% and 7.84%, respectively. A total of 68pathogenic bacteria strains were identified by culture from the 51 infected patients, of which Gram-negative bacteria, Gram-positive bacteria and fungi accounted for 50.00%, 44.12% and 5.88%, respectively. Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumoniae were the most common Gram-negative bacteria, accounting for 17.65%, 14.71% and 8.82%,respectively. Staphylococcus epidermidis and Staphylococcus aureus were the most common Gram-positive bacteria, accounting for 16.18% and 13.24%, respectively. Gram-negative bacteria were more resistant to levofloxacin, cefepime, cefotaxime,ceftazidime, cefazolin, piperacillin/tazobactam, ampicillin/sulbactam, and amoxicillin/clavulanic acid. Gram-positive bacteria were more resistant to erythromycin, clindamycin, cotrimoxazole, levofloxacin, and cefepime. Univariate analysis showed that anemia, hospital stay ≥30 d, hemoglobin level <90 g/L, albumin level <30 g/L, and catheter indwelling time ≥4 d were factors influencing infection after renal transplantation(P<0.05). Multivariate logistic regression analysis showed that anemia(OR=1.419, 95%CI: 1.146-1.757), hospital stay ≥30 d(OR=1.406, 95%CI: 1.152-1.718), hemoglobin level <90 g/L(OR=1.426,95%CI: 1.136-1.790), albumin level <30 g/L(OR=1.420, 95%CI: 1.141-1.769), and catheter indwelling time ≥4 d(OR=1.433,95% CI: 1.162-1.768) were independent risk factors for the infection after renal transplantation(P <0.05). Conclusion The infection rate after kidney transplantation is high, and respiratory system is a susceptible site. Gram-negative bacteria are main pathogenic bacteria, and most bacteria are resistant to antibiotics. Clinical monitoring of pathogenic bacteria should be strengthened, and antibiotics should be selected rationally based on drug susceptibility tests. The Anemia, length of hospital stay≥30 d, hemoglobin level <90 g/L, albumin level <30 g/L, and catheter indwelling time ≥4 d are independent risk factors for the infection after kidney transplantation. Clinical intervention on the risk factors should be conducted to lower the infection rate.