肾移植术后产NDM型金属β-内酰胺酶CRKP感染治疗的效果研究  

Clinical outcomes after treatment for NDM-producing Klebsiella pneumoniae infection after kidney transplantation

作　　者：李潇 张江伟 田晓辉[1] 燕航[1] 冯新顺[1] 薛武军[1] 陈若洋 李大伟[2] 袁晓东 丁小明[1] Li Xiao;Zhang Jiangwei;Tian Xiaohui;Yan Hang;Feng Xinshun;Xue Wujun;Chen Ruoyang;Li Dawei;Yuan Xiaodong;Ding Xiaoming(Department of Kidney Transplantation,The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Urology,Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200120,China)

机构地区：[1]西安交通大学第一附属医院肾移植科,西安710061 [2]上海交通大学医学院附属仁济医院泌尿外科,上海200120

出　　处：《中华器官移植杂志》2023年第5期298-303,共6页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金(81970670、81970668、81670682)。

摘　　要：目的探讨头孢他啶/阿维巴坦联合氨曲南治疗肾移植术后产新德里金属β内酰胺酶(NDM)耐碳青霉烯类肺炎克雷伯菌(CRKP)感染的临床效果。方法回顾性分析2018年11月至2019年12月西安交通大学第一附属医院和上海交通大学附属仁济医院收治的11例感染产NDM型金属β-内酰胺酶CRKP的肾移植受者临床资料, 根据抗感染治疗方案不同分为头孢他啶/阿维巴坦-氨曲南组(CZA-ATM组, 5例)以及其他有效抗生素组(OAA组, 6例), 分析比较两组受者的年龄、性别、感染类型、耐药基因、体温及白细胞计数变化、疗程和预后等。结果全部11例感染受者的年龄为(38.9±14.4)岁, 范围在19~66岁, 7例为男性, 4例为女性。3例受者为肺部和泌尿系混合感染, 2例为泌尿系感染, 1例为肺部感染, 5例为肾周感染。所有分离菌株均含有NDM型碳青霉烯酶基因, 其中5例分离株同时携带KPC型碳青霉烯酶基因, 1例分离株同时含有IMP和VIM碳青霉烯酶基因。5例受者采用CZA-ATM作为治疗方案, 6例使用其他有效抗生素(OAA)进行治疗。使用CZA-ATM治疗的受者未发生不良反应, 有2例使用OAA治疗的受者发生纳差和腹泻的不良反应。CZA-ATM和OAA组受者感染发生后30 d的治愈例数分别为4例和5例, 两组30 d均无受者死亡;CZA-ATM组治疗90 d无受者死亡, OAA组1例死于感染性休克。结论对于感染产NDM型碳青霉烯酶CRKP的肾移植受者, CZA联合氨曲南可能是一种有效的治疗方案。Objective To explore the clinical efficacy of ceftazidime/avibactam(CZA)plus aztreonam(ATM)for New Delhi metallo-β-lactamase(NDM)carbapenem-resistant Klebsiella pneumoniae(CRKP)infection after kidney transplantation.Methods Clinical data are retrospectively reviewed for 11 RT recipients infected with NDM metallo-β-lactamase CRKP admitted into First Affiliated Hospital of Xi'an Jiaotong University and Affiliated Renji Hospital of Shanghai Jiao Tong University from November 2018 to December 2019.Based upon treatment protocol,they are divided into two groups of ceftazidime/avibactam plus aztreonam(CZA-ATM,5 cases)and other effective antibiotics(OAA,6 cases).Age,gender,infection type,drug resistance gene,changes in body temperature and leucocyte count,treatment course and prognosis are summarized.Results A total of 11 patients with NDM-producing CRKP infection after RT are recruited.There are seven males and four females with an age range of(19~66)(38.9±14.4)years.There are mixed pulmonary and urinary tract infections(3 cases),urinary tract infection(2 cases),pulmonary infection(1 case)and perirenal infection(5 cases).All isolates harbore NDM carbapenemase gene,5 isolates carry Klebsiella pneumoniae carbapenemase(KPC)gene and 1 isolate contained both imipenemase metallo-β-lactamase(IMP)and verona integron-encoded metallo-β-lactamase(VIM)gene concurrently.Ceftazidime-avibactam plus aztreonam(CZA-ATM)is prescribed in five patients while the remainders receive OAA.No adverse reactions occurred in individuals on CZA-ATM and 2 cases on OAA have adverse reactions with a poor appetite and diarrhea.After 30-day infection,the curative cases of CZA-ATM and OAAs groups reach 4 and 5 respectively.No death occurred in neither groups at Day 30.And 90-day mortality is 0 and 1 respectively.Conclusions For RT patients infected with NDM-producing CRKP,CZA-ATM combination therapy may be another effective treatment.

关 键 词：肾移植 肺炎克雷伯菌 抗生素 

分 类 号：R699.2[医药卫生—泌尿科学]