肝移植受者鲍氏不动杆菌阳性检出特征及临床因素分析  

Clinical peculiarity and related factors of positive detection of Acinetobacter baumannii in recipients after liver transplantation

作　　者：张薇[1] 邹卫龙[2] 梁慧[1] 刘丽萍[1] 韩斌[1] 崔娟红[1] 

机构地区：[1]武警总医院检验科,北京100039 [2]武警总医院移植科,北京100039

出　　处：《军事医学》2012年第9期690-693,共4页Military Medical Sciences

摘　　要：目的观察肝移植术后鲍氏不动杆菌阳性检出的分布和药敏情况,分析阳性检出受者的临床特征及其临床相关因素。方法分析2007年1月至2010年10月161份肝移植受者鲍氏不动杆菌阳性样本的定植分布特征及药敏结果;回顾性地比较不同阳性分布来源患者的术前相关风险因素、临床特征及对预后的影响。结果阳性样本主要来自痰液(58.39%,94/191)、腹腔引流液(18.01%,29/161)、静脉导管尖端(8.70%,14/161)、胆汁(7.45%,12/161)和血液(7.45%,12/161);除2009年腹腔引流液阳性率高于其他年度外(2=15.294,P=0.002),阳性分布没有显著性年度差异。敏感率较好的抗生素依次为黏菌素、多黏菌素、米诺环素、头孢哌酮舒巴坦;碳青霉烯类耐药率高达85.09%(137/161)。阳性分布与术前应用三代头孢菌素显著相关(2=14.117,P=0.007)并严重影响患者ICU停留时间(F=2.681,P=0.034)、机械通气时间(F=4.281,P=0.003)和手术后早期死亡率(2=15.450,P=0.004);血液和胆汁培养阳性患者具有更高的临床风险。结论耐药鲍氏不动杆菌定植是肝移植术后医院内感染的重要风险因素,血液、胆汁培养阳性检出往往伴有严重后果,应引起足够重视。Objective To observe the distribution and the susceptibility to antibiotics of positive specimens with Acinetobacter baurnannii, and to assess the clinical features and related factors in positive recipients after liver transplantation. Methods From Jan 2007 to Oct 2010, 161 consecutive positive specimens with A. baumannii from patients after liver transplantation were detected auording to distribution and susceptibility. A retrospective analysis was performed to evaluate the influence of distribution on risk factors, clinical features and clinical prognosis. Results Totally 161 positive specimens of A. baumannii were isolated from sputum（58.39% , 94/191 ）, intraperitoneal drainage（ 18.01% , 29/161 ） , catheter tips （8.70% , 14/161 ） , biliary drainage（7.45% , 12/161 ） or blood（7.45% , 12/161 ） , respectively. No difference of distri- bution of colonization was obsered between the years except a higher positive percentage in intraperitoneal drainage in 2009 （x^2 = 15. 294, P = 0. 002 ）. The top antibiotics sensitive to A. baumannii were colistin, polymyxin, minocycline, and cefoperazone-sulbactam while resistance to carbapenems reached up to 85.09% （ 137/161 ）. Significant relatioships were observed between the location of colonization and administration of the third generation of cephalosporins pre-transplantation （x^2 = 14. 117, P = 0. 007 ）. The positive isolations of A. baumannii from blood or biliary drainage meant prolonged ICU care duration （ F = 2. 681, P = 0. 034 ）, fortified requirement （ F = 4. 281, P = 0. 003 ） and a deteriorated survival rate （ X^2 = 15. 450, P = 0.004）. Conclusion Colonization of A. baumannii was an important risk factor for nosocomial infection after liver transplantation. More eoffention should be paid to positive isolations from blood or bile should because of their contribution to grave consequences.

关 键 词：肝移植 鲍氏不动杆菌 定植 耐药 生存率 

分 类 号：R446.5[医药卫生—诊断学]