全国13家肝移植中心肝移植围手术期受者预防用抗感染药物现状调查分析  

Investigation and analysis of prophylactic anti-infective drugs of liver transplantation in 13 liver transplantation centers in China

作　　者：刘怡[1] 刘东华[2] 颜妍 郭明星 王德礼 崔向丽 Liu Yi;Liu Donghua;Yan Yan;Guo Mingxing;Wang Deli;Cui Xiangli(Pharmacy Department,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Pharmacy,Affiliated Hospital of Qingdao University,Qingdao 266000,China;Department of Pharmacy,Tsinghua Changgeng Hospital,Tsinghua University,Beijing 102218,China)

机构地区：[1]首都医科大学附属北京友谊医院药学部,北京100050 [2]青岛大学附属医院药学部,青岛266000 [3]清华大学附属北京清华长庚医院药学部,北京102218

出　　处：《中华器官移植杂志》2025年第1期63-68,共6页Chinese Journal of Organ Transplantation

基　　金：国家卫生健康委医院管理研究所医院药学高质量发展研究项目(NIHAYS2302)。

摘　　要：目的调查肝移植中心围手术期抗感染药物预防应用现状,为进一步规范预防用药提供数据参考。方法利用问卷星设计并发布肝移植围手术期预防用抗感染药物问卷,共5个维度53个问题,包括医疗机构基本信息、围手术期病原微生物相关情况、经验性抗感染药物预防现状、抗感染药物预防策略调整、其他病原微生物的抗感染预防概况。根据调查结果对肝移植围手术期常见病原微生物种类、细菌预防用药种类、时机和疗程、抗细菌感染药物升级预防策略(如升级抗菌药物等级、延长抗菌药物应用时间)及其他病原微生物预防等特点进行归纳总结。结果共收集13家肝移植中心药师填写的问卷。13家肝移植中心肝移植受者围手术期最常见的病原微生物为革兰阴性杆菌,包括肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌。围手术期经验性药物预防选择最多抗细菌感染为头孢哌酮/舒巴坦和哌拉西林/他唑巴坦。给药时机:9家中心在术前0.5~1.0 h给药,3家在术前0.5 h内给药,1家在术前1.0 h内给药。预防用药疗程:活体捐献肝移植为多术后7 d内(10家),遗体捐献肝移植疗程延长,仅6家在7 d内。供者存在敏感菌感染时,9家中心升级预防策略:2家升级抗菌药级别或调整方案、5家延长预防疗程、2家无论是否存在定植或感染均按供者药敏结果予以抗细菌感染药物预防、5家如仅存在定植菌则不予预防或者根据供者的药敏结果予以药物预防。当供者存在多重耐药菌感染时,11家中心升级预防策略:7家升级抗细菌感染药物级别或调整方案、4家延长预防疗程、6家无论是否有定植菌或感染均按供者药敏结果予以抗细菌感染药物预防、1家在仅存在定植菌的情况下不予预防或根据供者的药敏结果药物预防、2家放弃肝移植。7家中心采取常规预防措施预防真菌感染,其中1家术前�Objective To investigate the current application status of prophylactic anti-infective drugs during the perioperative period in liver transplantation centers and provide data references for further standardizing prophylactic regimens.Methods A questionnaire comprising 53 questions across 5 dimensions was designed and released using the WJX platform.The dimensions included basic information about medical institutions,perioperative pathogenic microorganisms,current status of empirical antibacterial prophylaxis,adjustments to prophylactic anti-infective strategies,and an overview of prophylactic measures against other pathogens.Based on the survey results,the types of common perioperative pathogens in liver transplantation,types of prophylactic antibacterial drugs,timing and duration of administration,upgraded prophylaxis strategies(such as escalation of antibiotic classes or extension of drug application duration),and prevention strategies for other pathogens were summarized.Results A total of 13 completed questionnaires from pharmacists at liver transplantation centers were collected.The most common pathogens during the perioperative period were Gram-negative bacilli,including Klebsiella pneumoniae,Escherichia coli,Pseudomonas aeruginosa,and Acinetobacter baumannii.The most frequently used prophylactic antibacterial drugs were cefoperazone/sulbactam and piperacillin/tazobactam.Regarding the timing of administration,9 centers administered drugs 0.5 to 1.0 hour before surgery,3 within 0.5 hour,and 1 within 1 hour preoperatively.The prophylactic duration was within 7 days postoperatively for living donor liver transplantation in 10 centers,while for cadaveric donor liver transplantation,only 6 centers adhered to the 7-day duration.When donors had infections with sensitive bacteria,9 centers upgraded prevention strategies:2 centers escalated the antibiotic class or adjusted regimens,5 centers extended the duration of prophylaxis,2 centers implemented donor-specific susceptibility-guided antibacterial treatments regard

关 键 词：肝移植 围手术期 抗感染 预防 问卷调查 

分 类 号：R657.3[医药卫生—外科学]