肝移植术后革兰阳性菌的感染因素及病原菌分析  

Correlative Factors of Gram-positive bacteria Infection and Pathogen Analysis after Liver Transplantation

作　　者：申川[1] 周光文[1] 陈瑞[1] 党同科[1] 彭承宏[1] 李宏为[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院外科,上海200025

出　　处：《中华医院感染学杂志》2010年第20期3236-3238,共3页Chinese Journal of Nosocomiology

摘　　要：目的通过肝移植术后感染的特点、易感因素与治疗经验,探讨利奈唑胺在肝移植术后有免疫抑制剂背景下治疗各部位革兰阳性菌感染的临床疗效和安全性。方法回顾性分析2008年5月-2009年9月上海瑞金医院普外科肝移植收治15例肝移植术后严重感染患者病例,就感染部位、常见致病菌、导致感染的危险因素和抗菌药物治疗情况进行分析。结果移植术后革兰阳性菌感染逐年增多,革兰阳性球菌主要有金黄色葡萄球菌,以耐甲氧西林金黄色葡萄球菌为主,对替考拉宁、万古霉素、利奈唑胺敏感;革兰阴性菌以大肠埃希菌及肺炎克雷伯菌为主;感染部位肺部12例(48.0%)、腹腔8例(32.0%)、血液2例(8.0%)、切口感染2例(8.0%);利奈唑胺在移植术后,有免疫抑制剂背景下,治疗各部位革兰阳性菌感染有较高的临床疗效和安全性。结论肝移植术后细菌感染是严重并发症之一,应尽可能地减少各种感染危险因素,合理选择抗菌药物防治细菌感染。OBJECTIVE Based on the features,risk factors and treatment experiences of the postoperative infection of liver transplantation,to investigate the safety and clinical efficacy of linezolid in the treatment of Gram-positive bacterial infection in various parts of body with immunodepression after liver transplantation.METHODS Totally 15 cases with severe postoperative infections after liver transplantation in Surgical Department of Ruijin Affiliated Hospital from May 2008 to Sep 2009 were retrospectively analyzed,the infection portion,common pathogens,risk factors and antimicrobial treatments of the cases were investigated.RESULTS The Gram-positive bacterial infection after transplantation increased year by year,as well as the drug-resistant bacteria.In this study,Staphylococcus aureus infections were found in 11 cases（including MRSA in 7 cases）,MRSE in 2 cases,E.avium in 1 case,E.faecium in 4 cases（including VRE in 1 case）;E.coli in 2 cases,K.pneumoniae in 4 cases,Acinetobacter baumannii in 1 case;Candida albicans in 2 cases,polyinfection in 3 cases.Site of infection：the lungs in 12 cases（48.0%）,abdominal cavity in 8 cases（32.0%）,blood in 2 cases（8.0%）,incision infection in 2 cases（8.0%）.With immunodepression,linezolid was quite effective and safe in the treatment of Gram-positive bacterial infection after transplantation.CONCLUSION Bacterial infection is one of the severe complications after liver transplantation,the risk factors should be reduced and the antimicrobial agents should be rationally chosen.

关 键 词：肝移植 术后并发症 细菌感染 利奈唑胺 

分 类 号：R378[医药卫生—病原生物学]