肾移植术后感染病原菌特点及死亡风险  

Characteristics of infection pathogens and risk of death after kidney transplantation

作　　者：冼盈[1] 段智勤 李衡[3] 毕筱刚[1] 张扣兴[1] XIAN Ying;DUAN Zhi-qin;LI Heng;BI Xiao-gang;ZHANG Kou-xing(Department of General Intensive Care Unit,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510700,China;Department of General Ward,West District Hospital,The Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510000,China;Department of Kidney Transplantation,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510700,China)

机构地区：[1]中山大学附属第三医院综合ICU,广东广州510700 [2]广州医科大学附属第二医院西院区综合科,广东广州510000 [3]中山大学附属第三医院肾移植科,广东广州510700

出　　处：《中国感染控制杂志》2023年第5期539-546,共8页Chinese Journal of Infection Control

摘　　要：目的 探讨肾移植术后1年内感染病原菌分布规律及死亡的危险因素。方法 回顾性分析某院2018年1月-2020年12月接受异体肾移植术及随访的肾移植受者术后发生感染情况。分析术后1年内发生感染的患者不同时间段感染发生及病原菌分布情况,根据1年内的预后情况分为生存组和死亡组,比较两组患者临床资料的差异及死亡的危险因素。结果 纳入的326例肾移植受者中119例在术后一年内至少有一次感染,共发生感染145例次,共分离细菌71株、真菌31株、病毒26株。感染类型以肺部感染为主(53.1%),早期以细菌感染为主(86.1%),中晚期真菌和病毒感染增加。生存组104例,死亡组15例,肺部感染、机会性感染是导致肾移植术后感染死亡的主要原因。与生存组相比,死亡组患者发生肾功能延迟恢复、急性排斥反应比例较高;术后28天血清清蛋白水平较低;FK506血药浓度较高,差异均有统计学意义(均P<0.05)。二元logistic回归分析显示,术后移植肾功能延迟恢复是感染相关死亡的独立危险因素(OR=4.479,P<0.05),高血清清蛋白水平为(OR=0.266,P<0.05)保护性因素。结论 肾移植患者死亡的主要原因是术后肺部感染和机会性感染,临床医务人员需重点关注发生肾功能延迟恢复的患者并监测患者术后血清清蛋白水平变化。Objective To explore the distribution pattern of infection pathogens and risk factors for death within one year after kidney transplantation.Methods Post-surgery infection in kidney transplant recipients who underwent allogeneic kidney transplantation in a hospital and were followed up from January 2018 to December 2020 were analyzed retrospectively.The occurrence of infection and distribution of pathogens of patients who developed infection in different periods within one year after surgery were analyzed.According to the prognosis within one year,patients were divided into the survival group and the death group.Clinical data and risk factors for death between two groups of patients were compared.Results Among the 326 kidney transplant patients,119 had at least once infection within one year after surgery,a total of 145 episodes of infection occurred.A total of 71 bacterial strains,31 fungal strains,and 26 viral strains were isolated.The main infection type was pulmonary infection(53.1%).Bacterial infection was the main cause(86.1%)at the early stage,while fungal and viral infection increased in the middle and late stages.There were 104 cases in the survival group and 15 cases in the death group.Pulmonary infection and opportunistic infection were the main causes of death caused by infection after kidney transplantation.Compared with the survival group,patients in the death group had higher proportion of delayed recovery of kidney function and acute rejection,lower level of serum albumin level 28 days after surgery,and higher blood drug concentration of FK506,with statistically significant differences(all P<0.05).Binary logistic regression analysis showed that delayed recovery of the function of transplanted kidney was an independent risk factor for infection-related death(OR=4.479,P<0.05),while high serum albumin level was a protective factor(OR=0.266,P<0.05).Conclusion Pulmonary infection and opportunistic infection are the main causes for death after kidney transplantation.Health care workers should pay attent

关 键 词：肾移植 手术后感染 死亡 危险因素 

分 类 号：R619.3[医药卫生—外科学]