肝移植术后细菌感染的菌群变迁及耐药性分析  

Analysis of bacterial variance and drug resistance after orthotopic liver transplantation

作　　者：李敏如[1] 蔡常洁[1] 陆敏强[1] 杨扬[1] 易慧敏[1] 许赤[1] 易述红[1] 汪根树[1] 陈规划[1] 

机构地区：[1]中山大学附属三院肝移植中心,中山大学器官移植研究所,广州510630

出　　处：《中华肝胆外科杂志》2008年第1期15-18,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：本项目受国家科技部973计划项目（2003CB515500）;广东省自然科学基金（4105344）;广州市科技计划项目（2005Z-3E0101）资助

摘　　要：目的研究肝移植术后细菌感染的菌群变迁及耐药性情况。方法对广州中山大学附属三院2004年1月至2005年10月485例病人原位肝移植术后细菌分离株及其耐药性情况进行回顾性分析。结果肝移植术后256例病人出现细菌感染，细菌感染率为52．9％（256／485），共分离出菌株356株，其中革兰阳性（G^＋）球菌占60．1％（214／356），革兰阴性（G^-）杆菌占39．9％（142／356）。耐甲氧西林金黄色葡萄球菌和耐甲氧西林表皮葡萄球菌的检出率分别为81％（66／82）和66．7％（28／42），超广谱β内酰胺酶的检出率大肠埃希菌为66．6％（16／24），肺炎克雷伯菌为61．1％（11／18）。近两年G^＋球菌的菌株构成无明显差异，G^-杆菌中肠杆菌科细菌与非发酵菌两者的构成比例有显著性差异（P〈0.001）。结论肝移植术后细菌感染以条件致病菌及多重耐药菌为主。非发酵菌的感染率明显上升，应注意根据菌群变化特点调整抗生素的使用。Objective To investigate the bacterial variance and drug resistance after orthotopic liver transplantation （OLT）. Methods The bacterial variance and drug resistance of 485 patients receiving OLT in our hospital from January 2004 to October 2005 were retrospectively analyzed. Results The bacterial infection was detected in 256 patients （52.9%）. The gram-positive bacilli accounted for 60. 1% （214/356） and gram-negative bacilli for 39.9% （142/356）. The detectable rates of methicillin resistant staphylococcus aureus and methicillin resistant staphylococcus epidermidis were 81% （66/82） and 66.7% （28/42）, respectively. The rates of extended spectrum beta-lactamase in Enterococcus spp and Klebsiella pneumoniae were 66.6% （16/24） and 61.1% （11/18）, respectively. There was no difference in the constitute of G＋ bacilli. The major G bacilli was of enterobacteriaceae bacteria in 2004 and of non-fermentative bacteria in 2005. There was significant difference in the constituting percentage between the 2 years. Conclusion The bacterial infection rate is high after OLT and the infection is mainly due to opportunistic pathogenic bacteria and antibiotics multi-resistant bacteria. The rate of in- fection by non-fermentative bacteria increases prominently. The use of antibiotics in clinical practice should be adjusted according to the bacterial variance.

关 键 词：肝移植 感染 菌群变迁 

分 类 号：R446.5[医药卫生—诊断学]