肺移植术后早期合并下呼吸道感染的危险因素及病原体分布

Risk factors and pathogen distribution of early lower respiratory tract infection after lung transplantation

目的分析肺移植术早期合并下呼吸道感染(LTRI)的危险因素,总结常见的病原体及耐药情况。方法回顾性分析2021年8月至2022年4月在中日友好医院因肺移植术后而入住重症监护病房(ICU)的60例患者的临床资料。根据患者肺移植术后1周内是否出现LRTI将患者分为LTRI组(40例)和对照组(20例)。通过二元logistics回归分析LTRI的高危因素。统计肺移植术后早期合并LTRI常见病原体及耐药情况。采用SPSS 22.0统计软件进行数据分析。根据数据类型,组间比较分别采用t检验、Mann-Whitney U检验、χ^(2)检验及Fisher检验。结果67%(40/60)的肺移植受者在肺移植后早期发生LRTI。LRTI组使用限制使用级抗菌药物的时间高于对照组(P<0.05)。低体质量指数(OR=0.838,95%CI 0.710~0.989)、术后肺部存在多种细菌(OR=5.100,95%CI 1.267~20.528)、结缔组织病(OR=15.016,95%CI 1.364~165.276)和低血浆白蛋白(OR=0.878,95%CI 0.783~0.984)是肺移植后7 d内发生LRTI的独立危险因素(P<0.05)。病原体以细菌为主,占89.34%(109/122)。鲍曼不动杆菌[16(13.11%)]、铜绿假单胞菌[17(13.93%)]和肺炎克雷伯菌[17(13.93%)]是最常见的革兰阴性菌。根据药敏结果,54.55%(12/22)的铜绿假单胞菌为耐药菌,60.87%(14/23)的肺炎克雷伯菌为耐药菌,84.21%(16/19)的鲍曼不动杆菌为耐药菌。结论改善患者的营养不良状况、加强供肺筛选有利于早期识别和预防LRTI。肺移植术后早期引起肺部感染的病原体以细菌为主,耐药率高,临床医师应特别注意合理的抗感染治疗方案。

Objective To analyze the risk factors for early lower respiratory tract infection(LTRI)after lung transplantation and to summarize the common pathogens and drug resistance.Methods A retrospective study is made of data of the patients transferred to the intensive care unit(ICU)of China-Japan Friendship Hospital after lung transplantation from August 2021 to April 2022.The patients were divided into LTRI(n=40)and control groups(n=20)according to the development of LRTI within 1 week after lung transplantation.Binary logistic regression was used to analyze risk factors for LTRI.Common pathogens and the patients with drug resistance of the early LTRI after the lung transplantation were counted.SPSS 22.0 was used for statistical analysis.Data comparison between two groups was performed using t-test,Mann-Whitney U test,χ^(2)test or Fisher test,depending on data type.Results LRTI occurred in 67%(40/60)of the lung transplant recipients in the early post-transplant period,and the duration(d)of using restricted antibiotics was longer in the LRTI group than in the control group(P<0.05).Low body mass index(BMI)(OR=0.838,95%CI 0.710-0.989),presence of multiple bacteria in the postoperative lungs(OR=5.100,95%CI 1.267-20.528),connective tissue disease(OR=15.016,95%CI 1.364-165.276),and low serum albumin(OR=0.878,95%CI 0.783-0.984)were independent risk factors for LRTI within 7 d after lung transplantation(P<0.05).The pathogens were predominantly bacteria(89.34%,109/122).Acinetobacter baumannii[16(13.11%)],Pseudomonas aeruginosa[17(13.93%)]and Klebsiella pneumoniae[17(13.93%)]were the most common gram-negative bacteria.Testing for drug susceptibility showed resistance in 54.55%(12/22)of Pseudomonas aeruginosa,60.87%(14/23)in Klebsiella pneumoniae,and 84.21%(16/19)in Acinetobacter baumannii.Conclusion Improving patients′malnutrition and enhancing screening lung donors are conducive to early detection and prevention of LRTI.Pathogens causing early lung infections after the lung transplantation are predominantly bacteria with a high rate of drug resistance,and clinicians should pay special attention to rational anti-infective treatment regimen.