肝移植术后耐甲氧西林葡萄球菌感染的病原学特点和耐药性分析  

Infection characteristics and drug resistance of methicillin resistant Staphylococcus aureus after liver transplantation

作　　者：吕少诚[1] 李立新[1] 武峤[1] 郎韧[1] 李先亮[1] 樊华[1] 赵昕[1] 贺强[1] Lyu Shaocheng Li Lixin Wu Qiao Lang Ren Li Xianliang Fan Hua Zhao Xin He Qiang(Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China)

机构地区：[1]首都医科大学附属北京朝阳医院肝胆外科,北京100020

出　　处：《国际外科学杂志》2017年第7期456-459,共4页International Journal of Surgery

摘　　要：目的探讨肝移植术后耐甲氧西林葡萄球菌感染的病原学和耐药性特点。方法回顾性分析首都医科大学附属北京朝阳医院肝胆外科2011年1月-2016年4月170例行同种异体肝移植患者的临床资料，统计分析其术后发生耐甲氧西林葡萄球菌感染的发病率、病原学特点、分布情况和耐药性特点。结果本组资料中共有23例肝移植患者术后发生耐甲氧西林葡萄球菌感染，其感染发病率为13．53％（23／170）。23例患者中共分离出耐甲氧西林葡萄球菌27株，其中腹腔引流液标本中20株，占74．07％（20／27），最常见的菌种为溶血葡萄球菌、表皮葡萄球菌和人葡萄球菌，分别占29．63％（8／27）、22．22％（6／27）和14．81％（4／27）。药敏结果提示，耐甲氧西林葡萄球菌对青霉素、苯唑西林及甲氧西林类抗生素已经完全耐药；对环丙沙星、左氧氟沙星、莫西沙星等喹诺酮类抗生素也已广泛耐药，耐药率分别为63％（15／24）、63％（15／24）和58％（14／24）；对替考拉宁、万古霉素、利奈唑烷最为敏感，尚未检出耐药菌。结论耐甲氧西林葡萄球菌是肝移植术后常见的感染病原菌之一。常规预防性抗生素对此类病原菌治疗无效，替考拉宁、万古霉素和利奈唑烷可作为治疗首选。Objective To investigate the infection characteristics and drug resistance of methicillin resistant Staphylococcus aureus after liver transplantation. Methods Retrospectively analyzed the clinical data of 170 patients who underwent liver transplantation in Beijing Chaoyang Hospital, Capital Medical University between January 2011 and April 2016. The incidence, pathogenic characteristics, distribution and drug resistance of methicillin resistant Staphylococcus aureus were analyzed. Results In this research, the methicillin resistant Staphylococcus aurens infection occurred in 23 cases after liver transplantation, and the incidence rate was 13.53% （23/170）. There were 27 strains of pathogens had been isolated, and 74.07% （20/27） of pathogens were isolated from peritoneal drainage fluid. The most common methicillin resistant Staphylococcus aureus were Staphylococcus haemolyticus, Staphylococcus epidermidis and Staphylococcus hominis, accounting for 29.63% （8/27）, 22.22% （6/27） and 14.81% （4/27）. Drug sensitivity results indicated that the methicillin resistant Staphylococcus aureus were completely resistant to Penicillin, Oxacillin and Methicillin antibiotics. And the pathogens were extensively drug-resistant to Ciprofloxacin, Levofloxacin and Moxifloxacin, the resistance rates were 63% （15/24）, 63% （15/24） and 58% （14/24）. But the pathogens were sensitive to Teicoplanin, Vancomycin and Linezolid, and there have not been detected drug-resistant bacteria. Conclusions The infection of methicillin resistant Staphylococcus aureus is one of the most common pathogens after liver transplantation. Routine prophylactic antibiotics are not useful for the treatment, however, Teicoplanin, Vancomycin and Linezo]id can be used as the first choice of treatment.

关 键 词：肝移植 抗甲氧西林金黄色葡萄球菌 病原菌 耐药性 

分 类 号：R515[医药卫生—内科学] R657.3[医药卫生—临床医学]