肾移植术后供肾来源耐碳青霉烯类肺炎克雷伯菌感染九例诊疗经验  

Diagnosis and treatment in 9 cases of donor-derivedcarbapenem-resistant Klebsiella pneumoniae Infection after kidney transplantation

作　　者：吴佳晋 李大伟[1] 张明[1] 应亮[1] 钟晨 陈若洋 邱丰[1] 庄少勇 武昊宇[1] 袁晓东 Wu Jiajin;Li Dawei;Zhang Ming;Ying Liang;Zhong Chen;Chen Ruoyang;Qiu Feng;Zhuang Shaoyong;Wu Haoyu;Yuan Xiaodong(Kidney Transplant Center,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200120,China)

机构地区：[1]上海交通大学医学院附属仁济医院肾移植中心,20120

出　　处：《中华器官移植杂志》2019年第6期334-338,共5页Chinese Journal of Organ Transplantation

基　　金：上海申康中心医疗事业部新兴前沿项目(SHDC12017111);国家自然科学基金(81800657).

摘　　要：目的探讨肾移植供肾来源耐碳青霉烯类肺炎克雷伯菌(CRKP)感染的快速诊断方法及治疗方案。方法回顾性分析2017年3月至2019年5月期间9例肾移植术后发生供肾来源CRKP感染供、受者的临床资料及诊治经过。结果526例受者中,共9例受者术后经细菌培养或肺炎克雷伯杆菌碳青霉烯酶(KPC)基因检测确诊为供者来源CRKP感染,感染率为1.71%。其中1例使用碳青霉烯类抗生素联合替加环素为主的治疗方案,受者死亡,其余8例使用头孢他啶/阿维巴坦联合碳青霉烯类抗生素治疗方案,8例受者均存活,1例行移植肾切除。8例联合头孢他啶/阿维巴坦治疗病例中,5例使用标准剂量(3.75 g/d),3例使用高剂量(7.5 g/d)。标准剂量组中1例受者因移植肾动脉吻合口破裂出血而切除,切除后改用高剂量方案继续治疗,受者长期存活;高剂量组3例受者移植物均正常存活。结论KPC酶基因检测联合灌洗液入血培养瓶培养是快速准确诊断CRKP感染的有效手段,头孢他啶/阿维巴坦联合碳青霉烯类抗生素治疗移植术后供肾来源CRKP感染的效果确切,增加头孢他啶/阿维巴坦剂量可提高疗效,且未见明显不良反应。Objective To explore the rapid diagnosis and clinic treatment of donor-derived carbapenem-resistant Klebsiella pneumoniae(CRKP)infection in renal transplant recipients.Methods Retrospective analysis was performed for clinical data and the diagnosis and treatment of 9 renal transplant recipients with donor-derived CRKP infection from March 2017 to May 2019.Results Among 526 renal transplant recipients,nine were diagnosed with donor-derived CRKP infection by bacterial culture or KPC enzyme gene test.The infection rate was 1.71%.One recipient receiving carbapenem and tigecycline died while the remainders survived after a treatment of ceftazidime-avibactam and carbapenem.One recipient underwent graft resection.Among 8 recipients on ceftazidime-avibactam,5 cases received a standard dose of 3.75 g/d while another 3 cases had a high dose of 7.5 g/d.One patient in standard-dose group underwent graft resection due to an arteriorrhexis of artery anastomosis.After graft resection,the patient received a high dose of ceftazidime-avibactam and survived to date.The grafts of three patients in high-dose treatment group survived.Conclusions KPC enzyme gene detection plus injecting lavage fluid into blood culture bottle for bacterial culture is rapid and accurate for diagnosing donor-derived CRKP infection.A combination of ceftazidime-avibactam plus carbapenem is effective for donor-derived CRKP infection.A high dose of ceftazidime-avibactam may improve the efficacy without obvious side effects.

关 键 词：肾移植 感染 耐药菌 

分 类 号：R699.2[医药卫生—泌尿科学]