肺移植受者痰标本细菌培养和药敏试验结果:12例特点分析  

Bacterial culture and drug susceptibility test in phlegmy samples from recipients of lung transplantation:Characteristic analysis in 12 cases

作　　者：肖华龙[1] 强新晨[1] 张晓峰[1] 周丽珍[1] 孙剑[1] 陈云清[1] 

机构地区：[1]江南大学附属无锡市第五人民医院检验科,江苏省无锡市214073

出　　处：《中国组织工程研究与临床康复》2007年第21期4066-4069,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：目的:了解肺移植受者感染病原菌的分布及其对抗菌药物的耐药情况,为临床合理使用抗生素提供依据。方法:选择2003-06/2005-05在江南大学附属无锡市第五人民医院进行肺移植的受者12例,术前均知情并签署手术同意书。其中双肺移植3例(男1例,女2例),单肺移植9例(均为男性)。在肺移植前后分别对受者深部脓性痰标本镜检筛选合格标本,将合格标本接种于平板培养基培养,对可疑菌落进行分离,采用法国梅里埃公司VITEK-32全自动微生物分析系统各种细菌鉴定卡和药敏试验卡进行细菌鉴定和药敏试验。结果:①12例肺移植受者移植前后痰标本中分离出各种细菌14种,肺移植前培养出阳性标本8例,其中2例为1种细菌,6例为2种以上的细菌混合感染。移植术前,对培养出阳性的肺移植受者抗感染治疗至痰培养阴性。在移植后3d内,每天连续培养均未检出阳性标本,第4天起开始有阳性标本出现。肺移植后培养出阳性标本10例,其中4例为1种细菌,6例为2种以上的细菌混合感染。②肺移植前后共分离出菌株48株,G+菌28株,占58.3%(28/48);G-菌9株,占18.8%(9/48);真菌11株占22.9%(11/48)。感染的主要病原菌除对磷霉素、万古霉素较为敏感外,其他均有多药耐药性。结论:在肺移植前后受者痰内均可培养分离出多种致病菌,肺部感染是普遍存在的问题。药敏试验结果表明,多数菌株具有多药耐药性。因此,分析肺移植受者痰液标本的细菌种类及耐药性情况对临床合理选择抗菌药物,避免盲目经验用药,及时控制感染有重要意义。AIM： To understand the distribution range of bacterium on the recipients of lung transplantation infected and its drug tolerance, and to provide evidences for the rational use of antibiotics in the clinic therapy. METHODS：Totally 12 recipients of lung transplantation in Wuxi Fifth People＇s Hospital Affiliated to Southern Yangtze University were selected from June 2003 to May 2005. They knew the fact and signed the informed consent before operation, Three of them （1 male, 2 females） were transplanted in both lungs, and the others （9 males） were single transplant. Sputum specimens of subjects were screened by microscope before and after lung transplantation and qualified ones were cultured on the fiat medium. The suspect bacterium were separated and tested by VITEK-32 microbiology autoanalysis system. The pathogen strains were analyzed and drug susceptibility test was done. RESULTS： （1）14 bacterium were separated from 12 recipients. 8 phlegmy samples before lung transplant from the recipients had been infected with pathogen, and 1 genus bacterium on the 2 samples and more than 2 genus bacterium on the 6 samples were found. Before transplantation, recipients with positive lung transplant received anti-infection therapy till sputum culture was negative. No positive specimen was checked out within 3 days after transplantation. Positive specimen was seen from the 4^th day. After transplantation totally 10 positive samples were found, and 1 genus bacterium on the 4 samples and more than 2 genus bacterium on the 6 samples. （2）A total of 48 pathogen strains were isolated from these samples. The pathogen strains that were found contain 28 G＋pathogenle bacterium （28/48, 58.3%）, 9 G-pathogenic bacterium （9/48, 18.8%） and 11 pathogenic fungus （11/48, 22.9%）. The bacterium and fungus were drug resistance to other antibiotics, except for phosphonomycin and vancomycin. CONCLUSION： Various pathogenic bacteria can be isolated and cultured in sputum of recipients before and after lung transpl

关 键 词：肺移植 痰/微生物学 细菌学技术 药物耐受性 器官移植 

分 类 号：R617[医药卫生—外科学]