肝移植病人术后早期病原学与感染的临床研究

Pathogen and Clinical Features of Infections in Early Stage after Liver Transplantation

目的探讨肝移植术后病人感染的临床特点 ,以助临床处理。方法对 5 4例肝移植病人术后针对感染进行各个系统定期检测 ,观察感染发生时间、部位、病原谱及药物敏感性等指标。结果 5 4例病人中感染率为 5 1 .9% ,2例因感染致死。 89.3 %的感染发生在术后 1月内。感染的病原菌依次为肺炎克雷伯菌、铜绿假单胞菌、粪肠球菌、鲍蔓 /溶血不动杆菌等。呼吸道感染占 92 .8% ,其中单独呼吸道感染占 4 2 .8% ,呼吸道合并其他部位感染占5 0 .0 % ;5 3 .8%的呼吸道感染是多种病原菌混合感染 ,大多伴有真菌感染 ,胆道、腹腔等其它部位感染以单一病原菌为主。病原菌中 G+菌对万古霉素敏感性较高 ,对头孢类和其它大部分抗生素有较高耐药率 ;G-菌对亚胺硫霉素普遍敏感 ,而对其它抗生素表现出不同程度的耐受。结论肝移植病人术后感染是影响存活的重要因素 ,应重视移植术前后对病人的监测和预防性抗生素处理等措施 ;在处理感染病情时 ,应综合考虑病原菌谱、药敏结果。

Objective To study the characteristics of infection in patients after liver transplantation. Method A prospective study of 54 patients after liver transplantation was carried out. All the patients accepted periodic detection to determine the infection incidence, time, infected organ or system, pathogen and antibiotic sensitivity. Results The infection incidence after liver transplantation was 51.9%(28/54) and 2 patients died of infection. 89.3%(25/28)infection episode occurred in one month after liver transplantation. The pathogenic bacteria, from high to low frequency, included Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis, Acinetobacter baumannii/haemolyticus and so on. Among total infections, the rate of respiratory tract infection reached 92.8%(26/28),and 42.8%(12/28) of which were single respiratory tract infection. Among respiratory tract infections,53.8%(14/26) were poly-bacterial, and most of these infections mixed with bacteria and fungus. Most gram-positive(G+) bacteria were sensitive to vancomycin but resistant to most other antibiotic. Most gram(G-) bacteria were sensitive to imipenem but resistant to a lot of antibiotic to varied degree. Conclusion Post-transplantation infection plays an important role on affecting the prognosis. Pre- and post-transplantation monitoring and prophylactic antibiotic treatment should be emphasized. While dealing with infection episode, microbial population, antibiotic resistance, infected organs and etiological factors should be considered synthetically.