肾移植术后患者的早期感染来源及致病菌株耐药性分析  

Analysis of infection factors and drug resistance of pathogenic strains in early stage of post-kidney transplantation

作　　者：徐媛 刘宝 牛玉林 晁晟 张涛 杨麒臻 潘光辉 李海洋 XU Yuan;LIU Bao;NIU Yulin;CHAO Sheng;ZHANG Tao;YANG Qizhen;PAN Guanghui;LI Haiyang(Organ Transplantation Center,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou,China;Department of Laboratory Science,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou,China)

机构地区：[1]贵州医科大学附属医院器官移植中心,贵州贵阳550004 [2]贵州医科大学附属医院检验科,贵州贵阳550004

出　　处：《贵州医科大学学报》2022年第12期1465-1469,1476,共6页Journal of Guizhou Medical University

基　　金：贵州省卫生健康委科学技术基金项目(gzwkj2023-164);贵州医科大学附属医院国家自然科学基金地区基金培育计划(2021-36)。

摘　　要：目的分析肾移植(KT)术后患者的早期感染来源及病原菌耐药性。方法记录196例KT术后12月内患者的感染来源,并对患者留存的送检标本进行细菌培养、分离鉴定病原菌类型及药物敏感试验,分析致病菌株的耐药率情况。结果196例KT患者术后发生感染72例,感染率36.73%;送检标本1792例次,检出阳性结果127例次(7.09%);常见的感染部位是尿路感染和以供肾血管组织、灌洗液阳性表现的供体来源感染;检出感染病原菌127株,其中革兰阴性杆菌76株、革兰阳性球菌42株、真菌9株;药敏实验结果显示,KT术后革兰阴性杆菌多为多重耐药或泛耐药菌群,其中嗜麦芽黄单胞菌、大肠埃希菌和鲍曼不动杆菌的耐药率最高;KT术后患者分离革兰阳性球菌耐药率最高的是溶血葡萄球菌,所有革兰阳性球菌均对万古霉素和利奈唑胺敏感;抗生素中头孢西丁钠、头孢唑林钠、氨苄西林以及厄他培南等在多个菌群中耐药率高达100%,达托霉素、呋喃妥因及喹奴普丁/达福普汀的耐药率较低。结论KT患者术后早期较易发生耐药菌群感染,留存标本进行病原学培养有利于合理选用抗生素。Objective To investigate the sources of early infection and drug resistance of pathogenic strains in patients after renal transplantation.Methods Recording sources of infection within 12 months of 196 patients received renal transplantation,and analyzing the drug resistance rate of pathogenic strains by performing bacterial culture,isolation/identification of pathogenic bacteria types and drug sensitivity tests on specimens of patients.Results Seventy-two out of 196 renal transplantation patients occurred infection(infection rate of 36.73%);one hundred and twenty-seven out of 1792 tested samples were positive(7.09%);the common sites of infection were urinary tract infections and donor-sourced infections that were positive for renal vascular tissue and lavage fluid.One hundred and twenty-seven strains of pathogenic bacteria were detected,including 76 Gram-negative bacilli,42 Gram-positive cocci and 9 fungi.The results of drug sensitivity tests showed that most of the post-transplantation Gram-negative bacilli were multi-drug resistant or pan-drug resistant colony,of which the resistance rates of Xanthomonas maltophilia,Escherichia coli,and Acinetobacter baumannii were the highest.Hymolytic sraphylococcus showed the highest drug resistance rate in isolating Gram-positive cocci.All Gram-positive cocci were sensitive to vancomycin and Linezolid.Cefoxitin sodium,cefazolin sodium,ampicillin,and ertapenem showed resistance rate of 100%in several groups of bacteria,while daptomycin,furantoin,and quinupristin/dalfoptine showed a low resistance rate.Conclusion Kidney transplant patients are more likely to develop drug-resistant flora infections in early postoperative period,and retention of specimens for pathogenic culture is beneficial for rational selection of antibiotics.

关 键 词：肾移植 感染 多重耐药 病原学 抗生素 

分 类 号：R692[医药卫生—泌尿科学]