肾移植术后继发尿路感染的回顾性分析  

Retrospective analysis of secondary urinary tract infection after kidney transplant operation

作　　者：邓聪[1] 康嘉乐[1] 林梅双[1] 周强[1] DENG Cong;KANG Jiale;LIN Meishuang;ZHOU Qiang(Department of Clinical Laboratory,the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou,Guangdong 510260,China)

机构地区：[1]广州医科大学附属第二医院检验科

出　　处：《重庆医学》2019年第21期3622-3625,3630,共5页Chongqing medicine

基　　金：广州市卫生健康科技一般引导项目(20171A011308)

摘　　要：目的分析肾移植术后尿路感染(UTI)的发生率、病原体谱、多重耐药菌比例、相关危险因素及其对肾功能的影响。方法回顾性分析2016年8月至2017年8月在广州医科大学附属第二医院器官移植科接受肾移植的308例患者的临床资料,对其在随访期内尿液培养、药敏试验、肾功能检查及其他临床资料进行总结分析。结果在(504.84±99.78)d的回访期内,308例患者中有69例(22.40%)发生UTI 173例次,其中无症状菌尿90例次(52.02%),下尿路感染53例次(30.64%),上尿路感染30例次(17.34%)。140例次(80.92%)UTI发生在术后6个月内。大肠埃希菌、肠球菌属及克雷伯菌属是位于前3位的病原体,其中产超广谱β-内酰胺酶(ESBLs)大肠埃希菌阳性率为55.07%,产ESBLs肺炎克雷伯菌阳性率为33.33%,未发现耐万古霉素肠球菌。女性、糖尿病、泌尿系统梗阻和双J管留置时间延长是UTI发生的独立危险因素。UTI组和非UTI组相比,肾功能并无明显变化。结论肾移植术后UTI临床表现以无症状菌尿居多且具有较高的上尿路感染发生率,多重耐药菌阳性率的上升需要密切关注,女性、糖尿病、泌尿系统梗阻和长时间留置双J管的患者是移植术后UTI发生的高危人群。Objective To analyze the incidence,pathogens spectrum,ratio of multi-drug resistant bacteria,related risk factors and influence on the renal function of urinary tract infection(UTI)after kidney transplant operation.Methods The clinical data of 308 patients receiving kidney transplantation in the Second Affiliated Hospital of Guangzhou Medical University from August 2016 to August 2017 were retrospectively analyzed.The results of urine culture,drug sensitivity test,renal function examination and other clinical data during the follow-up period were summarized and analyzed.Results Among 308 cases,69 cases(22.40%)developed 173 case-times of UTI during(504.84±99.78)d follow-up period,in which asymptomatic bacteriuria had 90 case-times(52.02%),lower urinary tract infection had 53 case-times(30.64%),and upper urinary tract infection had 30 case-times(17.34%).One hundred and forty case-times(80.92%)of UTI occurred within postoperative 6 months.Escherichia coli,Enterococcus spp.and Klebsiella spp were the pathogens placed in the top three.Among them,the positive rates of extended spectrum beta-lactamase producing Escherichia coli and Klebsiella pneumoniae were 55.07%and 33.33%respectivelly,no vancomycin-resistant Enterococci was found.The female gender,diabetes mellitus,urinary system obstruction and extension of double J catheterization indwelling time were the independent risk factors of UTI occurrence.There was no obvious change of renal function between the UTI group and non-UTI group.Conclusion The UTI clinical manifestations after renal transplant operation are dominated by asymptomatic bacteriuria,moreover with high occurrence rate of upper urinary tract infection.The positive rate increase of multi-drug resistant bacteria needs to be closely paied attention to.Female,diabetic patients,patients with urinary system obstruction or long term double J catheterization indwelling are the high risk populations developing UTI after kidney transplantation.

关 键 词：肾移植 泌尿道感染 致病菌 危险因素 

分 类 号：R617[医药卫生—外科学]