98例肾移植术后早期尿路感染的诊断及治疗:单中心经验总结  

Diagnosis and treatment for early urinary tract infections after renal transplantation: a single center experience of 98 cases

作　　者：王淮林 杨玉轩 朱海冬 王钢[1] 王远涛[1] 周洪澜[1] 翟秀宇[1] Wang Huailin;Yang Yuxuan;Zhu Haidong;Wang Gang;Wang Yuantao;Zhou Honglan;Zhai Xiuyu(Diagnosis and Treatment Ccenter of Urinary System Diseases,the First Hospital of Jilin University,Changchun 130021,Jilin,China)

机构地区：[1]吉林大学第一医院泌尿系统疾病诊治中心,吉林长春130021

出　　处：《实用器官移植电子杂志》2018年第3期199-202,共4页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：国家自然科学基金面上项目(81671574;81470975)

摘　　要：目的探讨肾移植术后早期尿路感染(UTI)的临床诊治策略。方法回顾性分析吉林大学第一医院2012年4月—2017年8月收治的98例肾移植术后早期UTI患者的临床资料,分析肾移植术后早期UTI的病原学结果及病因。结果 98例患者中,UTI频次累计130次,其中76例出现1次,16例出现2次,7例出现3次以上。患者多以发热、尿路刺激征为主要症状,住院时间为(10.3±4.4)天。130份尿培养病原学结果中,革兰阴性(G-)菌占51.5%,以大肠埃希菌、克雷伯杆菌为主;革兰阳性(G+)菌占8.5%,以肠球菌、葡萄球菌为主,病毒4.6%,为BK病毒、JC病毒、人巨细胞病毒(HCMV)病毒,混合感染15.4%,20.0%病原学结果阴性。留取血培养标本119份,15.1%为G-菌,1.5%为G+菌,余病原学阴性。入院前血肌酐为(132.7±63.0)μmol/l,出院时血肌酐为(110.9±62.3)μmol/l。患者均临床治愈,其中6例患者治疗期间出现移植肾排斥反应,抗排斥治疗后5例肾功能恢复至正常水平,1例出现移植肾功能衰竭。男性UTI发病率为14.4%,女性UTI发病率为24.6%。亲属肾移植UTI发病率为7.4%,其他类型肾移植UTI发病率为14.8%。结论 UTI病因与性别、年龄、移植类型、术中操作、免疫抑制剂、糖尿病、尿路异物(移植肾输尿管支架管、导尿管、造瘘管)等因素有关。男性UTI发病率较女性UTI发病率低。亲属肾移植UTI发病率较其他类型肾移植UTI发病率低。UTI以临床症状、尿液检验为诊断依据,治疗上除对因治疗外,依据血尿培养结果抗感染治疗,根据血药浓度调整免疫抑制剂剂量,并给予定期更换造瘘管、碱化尿液、增加入液量、增强免疫力、保持会阴清洁等对症支持治疗。早期预防UTI,有利于提高患者生活质量及移植肾存活时间。Objective To discuss clinical diagnosis and treatment strategy for early urinary tract infection（UTI） after renal transplantation. Methods A retrospective analysis for 98 early UTI patients was conducted who recept renal transplantation between April 2012 and August 2017 in the First Hospital of Jilin University. The laboratory results of pathogens for early UTI after renal transplantation were studied. Results In the 98 patients, 130 UTI patients were found, including 76 patients with UTI for one time, 16 patients with UTI for 2 times and 7 patients with UTI for more than 3 times. Major symptoms were fever and urinary tract irritation. The time of hospitalization was（10.3±4.4） days. Among the 130 results of urine cultures,the gram-negative bacilli was found in 51.5% cultures, mainly Escherichia coli and Klebsiella, while gram-positive bacilli accounted for 8.5%, mainly Enterococcus and Staphylococcus. Virus accounted for 4.6%, including BK, JC, HCMV virus,and the remaining（20%） was negative. In 119 blood cultures, gram-negative bacilli, gram-positive bacilli and negative accounted for 15.1%, 1.5% and 83.4%, respectively. The serum creatinine was（132.7±63.0） μmol/L before admission, while the serum creatinine was（110.9±62.3） μmol/L after treatment. All patients were clinically cured from UTI. Six cases of renal allograft rejectionoccurred. Five cases of renal allograft rejection recovered and one case appeared renal failure after anti rejection treatment. The incidence of UTI in male and female were 14.4% and 24.6%, respectively. The incidence of UTI in living related kidney transplantation and other renal transplantation were 7.4% and 14.8%, respectively. Conclusion UTI is related to gender, age, type of transplantation, intraoperative operation, immunosuppressant, diabetes and urinary foreign bodies（such as ureteral stent, catheter and fistulae）. The incidence of UTI in male is lower than that in female. The incidence of UTI in relative renal transplantation is lower than that in ot

关 键 词：肾移植术后 尿路感染 病原学 病因 诊断及治疗 

分 类 号：R699.2[医药卫生—泌尿科学]