肝移植术后早期细菌与真菌感染病原体分布及危险因素  

Pathogen distribution and risk factors of bacterial and fungal infections after liver transplantation

作　　者：吴小霞[1,2] 吴灵俐 万齐全 WU Xiaoxia;WU Lingli;WAN Qiquan(Department of Nursing,Third Xiangya Hospital,Central South University,Changsha 410013;Xiangya School of Nursing,Central South University,Changsha 410013;Transplantation Center,Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院护理部,长沙410013 [2]中南大学湘雅护理学院,长沙410013 [3]中南大学湘雅三医院移植科,长沙410013

出　　处：《中南大学学报（医学版）》2022年第8期1120-1128,共9页Journal of Central South University ：Medical Science

基　　金：中华国际医学交流基金会中青年医学研究专项基金(Z-2018-35-2003)。

摘　　要：目的:肝移植受者术后感染率高,识别出具有细菌与真菌感染高风险的患者将有利于预防疾病和改善肝移植受者的长期预后。本研究旨在了解肝移植术后早期(2个月内)细菌及真菌感染的病原菌组成、分布和预后,并分析其危险因素。方法:收集2020年5月至2021年10月在中南大学湘雅三医院行肝移植手术的受者发生细菌与真菌感染的病原体组成、分布和预后的数据,并分析感染发生的危险因素。结果:105例肝移植受者中75例发生了106株细菌或真菌感染,肝移植术后早期感染发生率为71.4%(75/105)。病原菌构成中G-杆菌处于优势(49/106,46.2%),G+球菌次之(31/106,29.2%)。G-杆菌中最常见者为鲍曼不动杆菌(13/106,12.3%)。G+球菌中最常见者为屎肠球菌(20/106,18.9%)。最常见感染部位为肺部感染(38/105,36.2%)及多部位感染(30/105,28.6%)。术后死亡6例(6/105,5.7%),均为感染患者。单因素分析显示术前终末期肝病模型(model for end stage liver disease,MELD)评分、术前半个月内抗生素使用、术前2个月内感染、术中红细胞输注量≥8 U、术后导尿管留置≥4 d及使用巴利昔单抗≥40 mg与感染发生有关;多元logistic回归分析显示仅术前两个月内感染(OR=5.172,95%CI:1.905~14.039,P<0.01)是肝移植术后细菌与真菌感染发生的独立危险因素,使用巴利昔单抗≥40 mg(OR=0.197,95%CI:0.051~0.762,P<0.05)的肝移植受者术后细菌与真菌感染率降低。结论:肝移植术后早期细菌与真菌感染发生率高,感染后病死率明显高于非感染患者,最常见感染部位为肺部,最多见病原体为G-杆菌。术前2个月内感染的受者术后易发生细菌与真菌感染。规范使用巴利昔单抗有助于减少肝移植术后感染的发生。Objective:Liver transplant recipients have a high rate of postoperative infection,and identification of patients at high risk for bacterial and fungal infections will help prevent disease and improve long-term outcomes for them.This study aims to understand the composition,distribution,prognosis of bacterial and fungal infections within 2 months after liver transplantation and to analyze their risk factors.Methods:The data of pathogen composition,distribution,and prognosis of bacterial and fungal infections among liver transplant recipients in the Third Xiangya Hospital of Central South University from May 2020 to October 2021 were collected,and the risk factors for these infections were analyzed.Results:A total of 106 episodes of bacterial or fungal infections occurred in 71.4%of liver transplant recipients(75/105).Gram-negative bacteria were the dominant pathogenic bacteria(49/106,46.2%),followed by Gram-positive bacteria(31/106,29.2%).The most common Gram-negative bacterium was Acinetobacter baumannii(13/106,12.3%).The most common Gram-positive bacterium was Enterococcus faecium(20/106,18.9%).The most common infections were pulmonary(38/105,36.2%)and multiple site infections(30/105,28.6%).Six(6/105,5.7%)patients with infections died within 2 months after liver transplantation.Univariate analysis showed that the model for end-stage liver disease(MELD)score≥25,antibiotic use within half a month before transplantation,infections within 2 months prior to transplantation,intraoperative red blood cell infusion≥8 U,indwelling urinary tract catheter≥4 days after transplantation,and the dosage of basiliximab use≥40 mg were associated with infections.Multivariate logistic regression analysis revealed that only infections within 2 months prior to transplantation(OR=5.172,95%CI 1.905-14.039,P<0.01)was an independent risk factor for bacterial and fungal infections after liver transplantation.Postoperative bacterial and fungal infections were reduced in liver transplant recipients receiving basiliximab≥40 mg(OR=0.

关 键 词：肝移植 细菌感染 真菌感染 危险因素 巴利昔单抗 

分 类 号：R657.3[医药卫生—外科学] R446.5[医药卫生—临床医学]