同种异体肝移植术后腹腔感染的病原菌分析及特点  

Analysis of pathogen characteristics and drug resistance for abdominal infection after liver transplantation

作　　者：吕少诚[1] 李立新[1] 赵昕[1] 郎韧[1] 樊华[1] 李先亮[1] 武峤[1] 贺强[1] 

机构地区：[1]首都医科大学附属北京朝阳医院肝胆外科,100020

出　　处：《北京医学》2017年第10期995-998,共4页Beijing Medical Journal

基　　金：国家自然科学基金面上项目(NSFC81273270)

摘　　要：目的总结同种异体原位肝移植术后腹腔感染的常见病原菌以及耐药性特点。方法总结我院2011年1月至2016年4月连续170例行同种异体原位肝移植术患者的临床资料,筛选出术后发生腹腔感染的患者,进而分析其常见病原菌的种类以及耐药性特点。结果本组170例中,术后发生腹腔感染者38例,发生率为22.35%,2种以上病原菌的混合感染占44.74%。培养出的71株病原菌中,革兰阴性菌占35.21%、革兰阳性菌占52.11%、真菌占12.68%。屎肠球菌、鲍曼不动杆菌和溶血葡萄球菌是最常见的病原菌,分别占19.72%、15.49%和11.27%。鲍曼不动杆菌对青霉素类、喹诺酮类和碳青霉烯类抗生素均已广泛耐药,耐药率达90%以上,仅对替加环素较为敏感,耐药率为27%。革兰阳性球菌对替考拉宁、万古霉素和替加环素最为敏感,真菌对氟康唑敏感。结论肝移植术后腹腔感染发生率高,常规广谱抗生素治疗效果差,应反复多次留取相关病原学检查并依据药敏结果合理使用抗生素。Objective To investigate the abdominal infection characteristics and drug resistance of the pathogens inpatients after liver transplantation, in order to guide the clinical treatment. Methods We retrospectively analyzed the clini-cal data of 170 patients underwent liver transplantation in Beijing Chaoyang Hospital between January 2011 and April 2016.And then the abdominal infection rate, pathogen and drug resistance characteristics were analyzed. Results In our research,postoperative infection occurred in 38 cases after liver transplantation and the incidence rate was 22.35%. Seventy-onestrains of pathogens were isolated, and mixed infection accounted for 44.74%. Gram negative strains accounted for 35.21%,Gram positive strains accounted for 52.11%, fungi accounted for 12.68%. The most common pathogens were Enterococcusfaecium, Acinetobacter Bauman and Staphylococcus haemolyticus, which were accounted for19.72%, 15.49% and 11.27%respectively. Drug sensitivity results suggested that： Acinetobacter Bauman had been extensively resistant to penicillins, qui-nolones and carbapenems antibiotics, the rates were higher than 90%, the only sensitive antibiotic was tigecycline, and theresistant rate was 27%. The gram positive bacteria were sensitive to vancomycin, teicoplanin and tigecycline. The funguswere most sensitive to fluconazole. Conclusion Patients after liver transplantation has a high incidence of abdominal infec-tion. The result of empiric antibiotic treatment is generally poor. We should do the pathogenic examination aggressively anduse the appropriate antibiotics according to the drug sensitivity test results.

关 键 词：肝移植 腹腔感染 病原菌 耐药性 

分 类 号：R657.3[医药卫生—外科学]