12例肾移植术后患者早期耐碳青霉烯类肺炎克雷伯菌感染致出血坏死性炎症的临床特征分析  

Hemorrhagic necrotic inflammation due to Carbapenem-resistant Klebsiella pneumoniaeinfection in early stage after kidney transplantation: A report of 12 cases

作　　者：王振[1] 柏宏伟[1] 李超[1] 杨锦涛 刘路鹏[1] 石炳毅[1] WANG Zhen;BAI Hongwei;LI Chao;YANG Jintao;LIU Lupeng;SHI Bingyi(Division of Urology of Chinese PLA General Hospital,Ward 2,Department of Urology,the Eighth Medical Center,Chinese PLA General Hospital,Beijing 100091,China)

机构地区：[1]解放军总医院泌尿外科学部,第八医学中心泌尿二科,北京100091

出　　处：《解放军医学院学报》2020年第12期1184-1187,1251,共5页Academic Journal of Chinese PLA Medical School

摘　　要：目的总结肾移植术后患者早期耐碳青霉烯类肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumoniae,CRKP)感染的临床表现、实验室检查、影像和病理检查结果,探讨其临床特征及机制。方法对2015年1月-2018年12月我中心确诊的12名肾移植术后早期(移植术后3个月内)CRKP感染患者进行回顾性研究。收集患者的症状、体征、实验室检查、化验检查及临床转归等临床特征信息。采用全自动微生物分析鉴定仪进行菌株的鉴定。应用Vitek 2全自动微生物分析鉴定系统联合纸片扩散法进行药物敏感实验。结果12例患者平均年龄为45.7岁,其中男性8例。11例发生感染相关的系统性炎症反应综合征,5例发生移植肾区出血,5例发现化脓性坏死分泌物;12例患者均伴随感染性指标如血中性粒细胞及降钙素原升高;且随感染时间长短、侵及组织器官不同而具有不容发的临床表现。移植肾病理检查结果显示移植肾内大量出血伴急性炎症细胞浸润,移植肾髓质内见微脓肿形成。药敏试验发现CRKP对替加环素(9例)和复方磺胺甲恶唑(5例)敏感。结论移植术后早期移植肾CRKP感染的本质是一种出血坏死性炎症,提示筛查供者CRKP、监测受者出血坏死性炎症征象,全程警惕并管控其引发出血风险是提高CRKP感染救治成功率的关键。Objective To explore the clinical and pathological characteristics of hemorrhagic necrotic inflammation due to Carbapenem-resistant Klebsiella pneumoniae allograft infection in early stage after kidney transplantation by summarizing its clinical manifestations,laboratory tests,imaging and pathological findings.Methods A single-center,retrospective and descriptive study of CRKP infections in early stage(within 3 months after transplantation)after kidney transplantation in our hospital from January 2015 to December 2018 was performed.The infection characteristics,laboratory testing results and clinical outcomes were collected.Bacterial susceptibility was tested by Vitek2 system and disk diffusion.Results The average age of 12 recipients was 45.7 years old and 8 cases were male.CRKP infections occurred within 1 month after transplant.The clinical manifestations included infection related systemic inflammatory response syndrome(11/12),hemorrhage(5/12)and purulent necrotic secretion(5/12),accompanied by the increase of infectious indexes such as leukocyte(12/12),C-reactive protein and procalcitonin(12/12).Clinical manifestations varied due to the duration of infection,and tissues/organs involved.Pathological examination showed presence of massive hemorrhage with acute inflammatory cell infiltration,and micro-abscess formation in the medulla of the transplanted kidney.Some CRKP were susceptible to tigecycline(9/12),and compound sulfamethoxazole(5/12).Conclusion CRKP infection in early stage after kidney transplantation is essentially a necrotic hemorrhagic inflammation,which suggests an urgent need for monitoring the signs of suppurative and hemorrhagic inflammation to early diagnosis and treatment.

关 键 词：出血坏死性炎症 耐碳青霉烯 肺炎克雷伯菌 移植物感染 肾移植 

分 类 号：R446.5[医药卫生—诊断学] R699.2[医药卫生—临床医学]