肝移植术后不同时期胆道感染的病原菌分布及耐药性的研究  

Distribution of pathogens causing biliary tract infections at different periods after liver transplantation and drug resistance

作　　者：江涛[1] 王轩[1] 陆雷[1] 张冬华[1] 张荣生[1] 

机构地区：[1]解放军第81医院南京军区肝移植中心,江苏南京210002

出　　处：《中华医院感染学杂志》2011年第2期403-406,共4页Chinese Journal of Nosocomiology

摘　　要：目的了解肝移植术后不同时期胆道感染病原菌的种类及其对常用抗菌药物的耐药率,以指导临床。方法对2003年4月-2009年12月肝移植术后35例不同时期出现胆道感染的患者培养出的69株细菌及其药敏试验结果进行统计学分析。结果标本的阳性检出率为72.5%,病原菌以大肠埃希菌、铜绿假单胞菌、粪肠球菌和牛链球菌多见,且术后不同时期的病原菌谱有显著不同,差异有统计学意义(χ2=4.483,P<0.05),术后早期以革兰阴性杆菌为主(72.2%),而在晚期常见革兰阳性球菌(53.8%);革兰阴性杆菌对亚胺培南(12.9%)、阿米卡星(32.3%)和头孢吡肟(32.3%)的耐药率较低,革兰阳性球菌对万古霉素(7.7%)和哌拉西林/他唑巴坦(34.6%)的耐药率较低。结论肝移植术后胆道感染的病原菌谱区别于与普通患者,其中大部分为多药耐药菌,治疗时应根据药敏试验选择合适抗菌药物。OBJECTIVE To survey the pathogen distribution and drug resistance of biliary tract infections at different time after liver transplantation to provide references for antibiotics application.METHODS The data of 69 strains of pathogen found in 35 postgraft patients with positive bile culture from Apr 2003 to Dec 2009 and their antibiotic susceptibility were statistically analyzed retrospectively.RESULTS The positive rate of bile culture was 72.5%.The most common pathogens for the infection were Escherichia coli,Pseudomonas aeruginosa,Enterococcus faecalis and Streptococcus bovis.Pathogen spectrum of different time post transplantation differed significantly（χ^2=4.483,P=0.034）,Gram negative bacteria dominated at early period and Gram positive cocci was common at late period.The average resistance rate of Gram negative bacteria was low to imipenem（12.9%）,amikacin（32.3%）,cefepime（32.3%） and that of Gram-positive cocci to vancomycin（7.7%）,piperacillin/tazobactam（34.6%）.CONCLUSION The pathogen spectrum of biliary tract infections after liver transplantation differs from common.Most of the pathogens are resistant to broad-spectrum antibiotics.The drug susceptibility test is essential to choose antibiotics for treatment of the infection.

关 键 词：肝移植 胆道感染 病原菌 抗菌药物 耐药性 

分 类 号：R378[医药卫生—病原生物学]