某大型医院同种异体肾移植患者医院感染病原菌与耐药性分析  

Analysis of nosocomial infection pathogens and drug resistance in patients with allogeneic renal transplantation in a large hospital

作　　者：顾雯霞[1] 陈浩 李占结 杨悦 张永祥 夏文颖 张卫红[5] 刘云 陈文森[3] GU Wen-xia;CHEN Hao;LI Zhan-jie;YANG Yue;ZHANG Yong-xiang;XIA Wen-ying;ZHANG Wei-hong;LIU Yun;CHEN Wen-sen(Kunshan Hospital Affiliated to Jiangsu University(The First People's Hospital of Kunshan),Suzhou,Jiangsu 215300,China;不详)

机构地区：[1]江苏大学附属昆山医院(昆山市第一人民医院)医院感染管理科,江苏苏州215300 [2]南京医科大学第一附属医院(江苏省人民医院)肾移植中心,江苏南京210029 [3]南京医科大学第一附属医院(江苏省人民医院)感染管理办公室,江苏南京210029 [4]南京医科大学第一附属医院(江苏省人民医院)检验学部,南京210029 [5]江苏省人民医院盛泽分院院长办公室,江苏苏州215228 [6]南京医科大学第一附属医院(江苏省人民医院)老年内分泌科,江苏南京210029 [7]南京医科大学医学信息学与管理研究所,江苏南京211166

出　　处：《中华医院感染学杂志》2020年第4期626-630,共5页Chinese Journal of Nosocomiology

基　　金：国家重点研发计划基金资助项目(2018YFC1314900,2018YFC1314901);江苏省科技厅基金资助项目(BE2016002-4)。

摘　　要：目的分析医院同种异体肾移植(简称肾移植)患者医院感染病原菌与耐药情况。方法通过检索电子病历,借助于医院感染监测平台,系统采集2012年10月-2018年10月于医院开展肾移植患者135例医院感染病原菌情况,并评估主要病原菌的耐药情况。结果77例供体进行病原学检测,16例培养阳性,供体阳性率20.78%(16/77),供体阳性肾移植患者医院感染率18.75%(3/16)。肾移植患者感染部位以消化系统感染,下呼吸道感染,泌尿道感染为主,共培养分离病原菌200株,其中革兰阴性菌86株占43.00%,以大肠埃希菌、肺炎克雷伯菌为主,对青霉素类、头孢菌素类、单酰胺环类、喹诺酮类等多种抗菌药物耐药率≥50%;革兰阳性菌22株占11.00%,以金黄色葡萄球菌和屎肠球菌为主,对青霉素和红霉素的耐药率均为100%,对替考拉宁和磺胺甲噁唑/甲氧苄啶的耐药率<15%,屎肠球菌对青霉素、氨苄西林和红霉素的耐药率均100%,未发现对万古霉素和利奈唑胺耐药的金黄色葡萄球菌和屎肠球菌;真菌92株占46.00%,以光滑假丝酵母、白假丝酵母为主,对常用抗真菌药的敏感性高。结论肾移植患者医院感染主要病原菌为光滑假丝酵母和大肠埃希菌,部分病原菌耐药情况严重,多药耐药菌检出率高,临床应根据药敏情况合理用药;供体感染情况不容忽视,临床医生应加强关注。OBJECTIVE To analyze the nosocomial infection pathogens and drug resistance in patients with allogeneic renal transplantation(renal transplantation).METHODS The infection status and pathogen distribution of renal transplantation patients were collected from Oct.2012 to Oct.2018 through the retrieval of electronic medical records and the hospital infection monitoring platform.And the drug resistance situation of the major pathogens was evaluated.RESULTS 77 renal donors were tested for pathogens,of which 16 donors were confirmed to be positive(16/77,20.78%).The nosocomial infection rate of donor-positive renal transplantation patients was 18.75%(3/16).The infection sites were gastrointestinal system(31.11%),lower respiratory tract(30.37%),and urinary tract(20.00%).A total of 200 strains of pathogens were isolated and cultured,among which 86 strains of gram-negative bacteria accounted for 43.00%,dominating by Escherichia coli and Klebsiella pneumoniae,and resistance rate to various antibiotics such as penicillins,cephalosporins,monoamide rings,quinolones,etc.was over 50%;22 strains of gram-positive bacteria accounted for 11.00%,dominating by Staphylococcus aureus and Enterococcus faecium,and resistance rate to both penicillin and erythromycin were 100%.resistance rate to teicoplanin and compound sulfamethoxazole were less than 15%.The resistance rate of E.faecium to penicillin,ampicillin and erythromycin were 100%,and no S.aureus and E.faecium resistant to vancomycin and linezolid were detected;92 stains of fungi accounted for 46.00%,mainly dominating by Candida glabrata and C.albicans,with high sensitivity to common antifungal drugs.CONCLUSIONS The main pathogens of nosocomial infection in renal transplant patients were C.glabrata and Escherichia coli.Some of the pathogens are highly resistant,and the detection rate of multi-drug resistant organisms was high.Clinicians should be rationally administered according to the drug sensitivity and pay attention to donor infections.

关 键 词：肾移植 医院感染 供体 病原菌 多药耐药菌 耐药 

分 类 号：R378[医药卫生—病原生物学]