老年患者肝移植术后感染的病原学和耐药性分析  

Etiology and drug-resistance of postoperative infection after orthotopic liver transplantation in patients over 60 years old

作　　者：曾纪晓[1] 何晓顺[1] 马毅[1] 王东平[1] 朱晓峰[1] 黄洁夫[1] 

机构地区：[1]中山大学附属第一医院器官移植科,广州510080

出　　处：《中华器官移植杂志》2007年第4期214-216,共3页Chinese Journal of Organ Transplantation

基　　金：广东省教育厅“千百十工程”人才基金（Q02033）;广州市科技攻关计划基金（2005Z3-E0041）

摘　　要：目的 探讨老年（≥60岁）患者肝移植术后感染的病原学、耐药性特点和相关的易感因素。方法 回顾性分析57例老年患者肝移植后的临床资料，对其术后发生感染的易感因素、发生率、发生部位、病原学特征、耐药性及感染死亡率进行总结。结果 57例老年肝移植患者中有40例（70．18％）术后发生感染，其中30例为混合性细菌感染，15例合并深部真菌感染，感染以多部位混合感染最为常见。经积极治疗，37例患者存活，存活率为64．91％；感染导致死亡9例，占死亡人数的45％；术后感染治愈率为77．5％。致病菌以屎肠球菌、耐甲氧西林凝固酶阴性葡萄球菌、嗜麦芽寡单胞菌、耐甲氧西林金黄色葡萄球菌、白色念珠菌等最为常见，其中大多数革兰氏阳性球菌对万古霉素、替考拉宁敏感，对其他常用药普遍耐药革兰氏阴性杆菌对亚安培南、美罗培南的耐药株多；对头孢三代普遍耐药；对头孢四代、喹诺酮类等敏感性高于其他药物。真菌对两性霉素B均敏感，但多数对酮康唑、益康唑、氟康唑耐药。结论 老年肝移植术后具有高感染率、高耐药率、高致死率等特点，应引起注意。Objective To investigate the etiology, drug-resistance and correlated predisposing factors of postoperative infection after orthotopic liver transplantation （OLT） in patients over 60 years older. Method The clinical data of 57 aged patients subject to OLT were retrospectively reviewed to analyze infection rate, genetic locus, etiology, drug-resistance and corresponding factors. Results Forty patients developed postoperative infection （70. 18%）, and among them 30 patient suffered from mixed bacterial infection, and 15 patients had coincident fungal infection. The most common location of infection was multi-locus. Thirty-seven cases survived after OLT （64. 91 %）, and 9 patients died of postoperative infection. The primary pathogenic germs included enterococcus, meticillin-resistant coagulase negative staphylococcus, meticillin-resistant staphylococcus aureus, candida albicans. Most Gram-positive bacteria were sensitive to vancomycin and teicoplanin, but showed high drug-resistant to other antibiotics. Most Gram-negative bacteria were multidrug-resistant to Meropenem, the third generation of cephem antibiotics, but they showed sensitive to Cefepime and Quinolone. Amphotericin B was effective for the patients with fungal infection. Conclusion The old patients subject to liver transplantation carry a hgh risk of postoperative infection which may lead a high mortality and drug-resistance.

关 键 词：肝移植 手术后并发症 抗药性 

分 类 号：R686[医药卫生—骨科学]