胰肾联合移植受者病原菌分布及耐药特征分析  

Distribution and drug resistance characteristics of pathogens in recipients undergoing simultaneous pancreas-kidney transplantation

作　　者：陈荣鑫[1] 方佳丽[1] 张磊[1] 李光辉[1] 刘路浩[1] 张鹏 吴佳林[1] 马俊杰[1] 郭泽彬 陈正[1] Chen Rongxin;Fang Jiali;Zhang Lei;Li Guanghui;Liu Luhao;Zhang Peng;Wu Jialin;Ma Junjie;Guo Zebin;Chen Zheng(Department of Organ Transplantation,the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 511447,China)

机构地区：[1]广州医科大学附属第二医院器官移植科,广州511447

出　　处：《器官移植》2023年第2期280-287,共8页Organ Transplantation

基　　金：广东省医学科学技术研究基金项目(A2020384);广州市临床重大科技项目(2019ZD12)。

摘　　要：目的探讨胰肾联合移植供、受者病原菌分布特点及耐药特征。方法回顾性分析231例胰肾联合移植供、受者的临床资料。供、受者标本采用VITEK-2分析仪进行病原菌鉴定,K-B法进行药敏试验。分析供受者标本病原菌来源分布与构成比、多重耐药菌分布特征、受者感染发生情况及病原菌耐药特征。结果供者1294份标本共培养出395株病原菌,检出率为30.53%。革兰阴性菌以肺炎克雷伯菌为主,革兰阳性菌以金黄色葡萄球菌为主,真菌主要为白假丝酵母菌。受者10507份标本共培养出2690株病原菌,检出率为25.60%。革兰阴性菌以嗜麦芽假单胞菌为主,革兰阳性菌以屎肠球菌为主,真菌主要为白假丝酵母菌。供者395株病原菌中,耐甲氧西林金黄色葡萄球菌(MRSA)15株、产超广谱β内酰胺酶(ESBL)阳性耐药菌16株、耐碳青霉烯类铜绿假单胞菌(CR-PA)8株、耐碳青霉烯类鲍曼不动杆菌(CR-AB)21株、耐碳青霉烯类肠杆菌科细菌(CRE)2株、多重耐药/泛耐药铜绿假单胞菌(MDR/PDR-PA)1株;受者2690株病原菌中,ESBL阳性耐药菌73株、CR-PA 44株、CR-AB 31株、MDR/PDR-PA 3株。受者发生供者来源性感染1例,术后1年内发生肺炎69例、泌尿系统感染52例、腹腔感染35例、血行感染2例。革兰阴性菌对部分抗生素耐药;革兰阳性菌对万古霉素敏感;真菌对两性霉素B敏感。结论革兰阴性菌是SPK受者主要感染病原菌,对部分抗生素耐药,未获得培养结果前可经验性应用抗生素,后根据结果合理选用敏感抗生素以提高SPK受者生存率。Objective To investigate the distribution and drug resistance characteristics of pathogens in donors and recipients undergoing simultaneous pancreas-kidney transplantation(SPK).Methods Clinical data of 231 pairs of donors and recipients undergoing SPK were analyzed retrospectively.The pathogens of samples from donors and recipients were identified by VITEK-2 analyzer,and drug sensitivity test was performed by K-B method.The source distribution and composition ratio of pathogens in donor and recipient samples,distribution characteristics of multi-drug resistant organism,infection of recipients and drug resistance characteristics of pathogens were analyzed.Results A total of 395 strains of pathogens were cultured from 1294 donor samples,and the detection rate was 30.53%.Gram-negative bacteria mainly consisted of klebsiella pneumoniae,Gram-positive bacteria mainly comprised staphylococcus aureus,and fungi primarily included candida albicans,respectively.In total,2690 strains of pathogens were cultured from 10507 recipient samples,and the detection rate was 25.60%.Gramnegative bacteria mainly consisted of pseudomonas maltophilia,Gram-positive bacteria primarily comprised enterococcus faecalis,and fungi mainly included candida albicans,respectively.Among 395 pathogens of donors,15 strains of methicillinresistant staphylococcus aureus(MRSA),16 strains of extended-spectrumβ-lactamase(ESBL)positive drug-resistant bacteria,8 strains of carbapenem-resistant pseudomonas aeruginosa(CR-PA),21 strains of carbapenem-resistant acinetobacter baumannii(CR-AB),2 strains of carbapenem-resistant enterobacteriaceae(CRE)and 1 strain of multiple-drug/pan-drug resistant pseudomonas aeruginosa(MDR/PDR-PA)were identified.Among 2690 strains of recipient pathogens,73 strains of ESBL positive drug-resistant bacteria,44 strains of CR-PA,31 strains of CR-AB and 3 strains of MDR/PDR-PA were detected.One recipient developed donor-derived infection,69 cases of pneumonia,52 cases of urinary tract infection,35 cases of abdominal infection and 2 cas

关 键 词：胰肾联合移植 病原菌 多重耐药菌 革兰阴性菌 革兰阳性菌 真菌 供者来源性感染 抗生素 

分 类 号：R617[医药卫生—外科学] R37[医药卫生—临床医学]