肝移植围手术期腹腔与胸腔感染病原学分析
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摘要
目的探究肝移植术后腹、胸腔感染常见病原菌分布及耐药情况。方法回顾性分析首都医科大学附属北京朝阳医院肝胆外科2011年1月至2017年12月343例行同种异体原位肝移植术受者临床资料,分析围手术期腹腔和胸腔感染情况、常见病原菌及耐药情况。腹、胸腔感染常见病原菌分布比较采用卡方检验,P<0.05为差异有统计学意义。结果 343例肝移植受者中,围手术期48例单独发生腹腔感染,61例单独发生胸腔感染,10例同时发生腹、胸腔感染,15例因感染导致死亡。发生腹腔感染的受者腹腔引流液共培养出106株病原菌,屎肠球菌、鲍曼不动杆菌和溶血葡萄球菌为最常见的病原菌,分别占19.8%(21/106)、15.1%(16/106)和11.3%(12/106)。发生胸腔感染的受者胸腔引流液共培养出99株病原菌,鲍曼不动杆菌、铜绿假单胞菌和肺炎克雷伯菌为最常见的病原菌,分别占26.3%(26/99)、18.2%(18/99)和17.2%(17/99)。腹、胸腔感染常见病原菌(鲍曼不动杆菌、屎肠球菌、溶血葡萄球菌、铜绿假单胞菌和肺炎克雷伯菌)感染分布差距均有统计学意义(χ~2=3.92、135.62、162.14、11.09和6.81,P均<0.05)。药敏试验结果示鲍曼不动杆菌对青霉素类、喹诺酮类和碳青霉烯类抗生素均已耐药(>90%),仅对替加环素较为敏感(27%);铜绿假单胞菌对碳青霉烯类和替加环素耐药率最低(11%);肺炎克雷伯菌对阿米卡星和替加环素耐药率最低(6%);革兰阳性球菌(屎肠球菌和溶血葡萄球菌)对替考拉宁、万古霉素和替加环素最为敏感;真菌对氟康唑最敏感。结论肝移植术后围手术期腹、胸腔感染发生率均较高,且病原学分布各有特点,术后应积极反复进行相关病原学检查,并根据药敏试验结果合理使用抗生素。
Objective To explore the distribution and drug resistance of common pathogens in abdominal and thoracic infection after liver transplantation. Methods Clinical data of 343 recipients underwent liver transplantation were analyzed retrospectively from January 2011 to December 2017 in the Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University. The occurrence of perioperative abdominal and thoracic infection, common pathogens and drug resistance were analyzed. Chi-square test was used to compare the common pathogenic bacteria infections between abdomen and thorax, P<0.05 was statistically significant. Results In 343 recipients of liver transplantation, 48 recipients got abdominal infection, 61 recipients got thoracic infection, 10 recipients got both abdominal and horacic infection, and 15 recipients died of infection. 106 strains of pathogenic bacteria were cultured by abdominal drainage, and the most common pathogenic in abdominal infection were enterococcus faecium [19.8%(21/106)], acinetobacter baumannii [15.1%(16/106)] and staphylococcus haemolyticus [11.3%(12/106)]. 99 strains of pathogenic bacteria were cultured by thoracic drainage, and the most common pathogenic in thoracic infection were acinetobacter bauman [26.3%(26/99)], pseudomonas aeruginosa [18.2%(18/99)] and klebsiella pneumoniae [17.2%(17/99)]. The occurrence of common pathogens(acinetobacter baumannii, enterococcus faecium, staphylococcus haemolyticus, pseudomonas aeruginosa and klebsiella pneumoniae) between abdominal and thoracic infection were significantly different(χ~2=3.92、135.62、162.14、11.09、6.81, P all<0.05). Drug susceptibility test showed that acinetobacter baumannii was resistant to penicillins, quinolones and carbapenems(90%), but sensitive to tegacycline(27%). The resistance rate of pseudomonas aeruginosa to carbapenems and tegacycline was the lowest(11%). The resistance rate of klebsiella pneumoniae to amikacin and tegacycline was the lowest(6%). Gram-positive cocci(enterococcus faecium and staphylococcus hemolyticus) were most sensitive to teicoplanin, vancomycin and tegacycline. Fungi was most sensitive to fluconazole. Conclusions The incidences of perioperative abdominal infection and thoracic infection are both high after liver transplantation, and the distribution of pathogenic bacteria have their own characteristics. Postoperative patients should be actively and repeatedly tested for pathogen and use effective antibiotics according to drug susceptibility results.
Objective To explore the distribution and drug resistance of common pathogens in abdominal and thoracic infection after liver transplantation. Methods Clinical data of 343 recipients underwent liver transplantation were analyzed retrospectively from January 2011 to December 2017 in the Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University. The occurrence of perioperative abdominal and thoracic infection, common pathogens and drug resistance were analyzed. Chi-square test was used to compare the common pathogenic bacteria infections between abdomen and thorax, P<0.05 was statistically significant. Results In 343 recipients of liver transplantation, 48 recipients got abdominal infection, 61 recipients got thoracic infection, 10 recipients got both abdominal and horacic infection, and 15 recipients died of infection. 106 strains of pathogenic bacteria were cultured by abdominal drainage, and the most common pathogenic in abdominal infection were enterococcus faecium [19.8%(21/106)], acinetobacter baumannii [15.1%(16/106)] and staphylococcus haemolyticus [11.3%(12/106)]. 99 strains of pathogenic bacteria were cultured by thoracic drainage, and the most common pathogenic in thoracic infection were acinetobacter bauman [26.3%(26/99)], pseudomonas aeruginosa [18.2%(18/99)] and klebsiella pneumoniae [17.2%(17/99)]. The occurrence of common pathogens(acinetobacter baumannii, enterococcus faecium, staphylococcus haemolyticus, pseudomonas aeruginosa and klebsiella pneumoniae) between abdominal and thoracic infection were significantly different(χ~2=3.92、135.62、162.14、11.09、6.81, P all<0.05). Drug susceptibility test showed that acinetobacter baumannii was resistant to penicillins, quinolones and carbapenems(90%), but sensitive to tegacycline(27%). The resistance rate of pseudomonas aeruginosa to carbapenems and tegacycline was the lowest(11%). The resistance rate of klebsiella pneumoniae to amikacin and tegacycline was the lowest(6%). Gram-positive cocci(enterococcus faecium and staphylococcus hemolyticus) were most sensitive to teicoplanin, vancomycin and tegacycline. Fungi was most sensitive to fluconazole. Conclusions The incidences of perioperative abdominal infection and thoracic infection are both high after liver transplantation, and the distribution of pathogenic bacteria have their own characteristics. Postoperative patients should be actively and repeatedly tested for pathogen and use effective antibiotics according to drug susceptibility results.
引文
1 陈规划, 汪根树. 移植肝脏病学:一门相对独立的新兴学科[J]. 器官移植, 2011, 2(1): 1- 3.
2 Vera A, Contreras F, Guevara F. Incidence and risk factors for infections after liver transplant: single- center experience at the University Hospital Fundación Santa Fe de Bogotá, Colombia[J]. Transpl Infect Dis, 2011, 13(6): 608- 615.
3 李明霞, 彭贵主, 王忍, 等. 肝移植术后感染研究进展[J]. 中华肝胆外科杂志, 2015, 9(7):494- 497.
4 中华人民共和国卫生部. 医院感染诊断标准(试行)[J]. 现代实用医学, 2003, 15(7): 460- 465.
5 Humar A, Michaels M. American Society of Transplantation recommendations for screening, monitoring and reporting of infectious complications in immunosuppression trials in recipients of organ transplantation[J]. Am J Transplant, 2006, 6(2): 262- 274.
6 Fagiuoli S, Colli A, Bruno R, et al. Management of infections pre- and post- liver transplantation: report of an AISF consensus conference[J]. J Hepatol, 2014, 60(5): 1075- 1089.
7 Pedersen M, Seetharam A. Infections after orthotopic liver transplantation[J]. J Clin Exp Hepatol, 2014, 4(4): 347- 360.
8 Li C, Wen TF, Mi K, et al. Analysis of infections in the first 3- month after living donor liver transplantation[J]. World J Gastroenterol, 2012, 18(16): 1975- 1980.
9 Mukhtar A, Abdelaal A, Hussein M, et al. Infection complications and pattern of bacterial resistance in living- donor liver transplantation: a multicenter epidemiologic study in Egypt[J]. Transplant Proc, 2014, 46(5): 1444- 1447.
10 Furuichi M, Fujiwara T, Fukuda A, et al. Fulminant hepatic failure as a risk factor for cytomegalovirus infection in children receiving preemptive therapy after living donor liver transplantation[J]. Transplantation, 2016, 100(11): 2404- 2409.
11 de Mare- Bredemeijer EL, Metselaar HJ. Optimization of the use of calcineurin inhibitors in liver transplantation[J]. Best Pract Res Clin Gastroenterol, 2012, 26(1): 85- 95.
12 丁利民, 李新长, 罗文峰, 等. 围手术期不同营养方式对肝移植术后早期感染的影响[J/CD]. 中华移植杂志: 电子版, 2017, 11(4): 211- 215.
13 卢建军, 李恒爱, 熊莺, 等. 肝移植术后患者医院感染的流行病学特征[J].中华医院感染学杂志,2018,(23):3598- 3601.
14 吴晓峰, 林栋栋. 肝移植术后肺部感染的危险因素[J]. 北京医学, 2014, 36(9): 766- 769.
15 Siniscalchi A, Aurini L, Benini B, et al. Ventilator associated pneumonia following liver transplantation: Etiology, risk factors and outcome[J]. World J Transplant, 2016, 6(2): 389- 395.
16 Ikegami T, Shirabe K, Matono R, et al. Etiologies, risk factors, and outcomes of bacterial pneumonia after living donor liver transplantation[J]. Liver Transpl, 2012,18(9):1060- 1068.
17 Friedrich- Rust M, Wanger B, Heupel F, et al. Influence of antibiotic- regimens on intensive- care unit- mortality and liver- cirrhosis as risk factor[J]. World J Gastroenterol, 2016, 22(16): 4201- 4210.
18 Gao F, Ye Q, Wan Q, et al. Distribution and resistance of pathogens in liver transplant recipients with acinetobacter baumannii infection[J]. Ther Clin Risk Manag, 2015,11: 501- 505.
19 安玉玲, 傅斌生, 吕海金, 等. 肝移植术后早期优化气道湿化和雾化吸入方案的疗效分析[J/CD]. 中华移植杂志: 电子版, 2015, 9(4): 160- 164.
2 Vera A, Contreras F, Guevara F. Incidence and risk factors for infections after liver transplant: single- center experience at the University Hospital Fundación Santa Fe de Bogotá, Colombia[J]. Transpl Infect Dis, 2011, 13(6): 608- 615.
3 李明霞, 彭贵主, 王忍, 等. 肝移植术后感染研究进展[J]. 中华肝胆外科杂志, 2015, 9(7):494- 497.
4 中华人民共和国卫生部. 医院感染诊断标准(试行)[J]. 现代实用医学, 2003, 15(7): 460- 465.
5 Humar A, Michaels M. American Society of Transplantation recommendations for screening, monitoring and reporting of infectious complications in immunosuppression trials in recipients of organ transplantation[J]. Am J Transplant, 2006, 6(2): 262- 274.
6 Fagiuoli S, Colli A, Bruno R, et al. Management of infections pre- and post- liver transplantation: report of an AISF consensus conference[J]. J Hepatol, 2014, 60(5): 1075- 1089.
7 Pedersen M, Seetharam A. Infections after orthotopic liver transplantation[J]. J Clin Exp Hepatol, 2014, 4(4): 347- 360.
8 Li C, Wen TF, Mi K, et al. Analysis of infections in the first 3- month after living donor liver transplantation[J]. World J Gastroenterol, 2012, 18(16): 1975- 1980.
9 Mukhtar A, Abdelaal A, Hussein M, et al. Infection complications and pattern of bacterial resistance in living- donor liver transplantation: a multicenter epidemiologic study in Egypt[J]. Transplant Proc, 2014, 46(5): 1444- 1447.
10 Furuichi M, Fujiwara T, Fukuda A, et al. Fulminant hepatic failure as a risk factor for cytomegalovirus infection in children receiving preemptive therapy after living donor liver transplantation[J]. Transplantation, 2016, 100(11): 2404- 2409.
11 de Mare- Bredemeijer EL, Metselaar HJ. Optimization of the use of calcineurin inhibitors in liver transplantation[J]. Best Pract Res Clin Gastroenterol, 2012, 26(1): 85- 95.
12 丁利民, 李新长, 罗文峰, 等. 围手术期不同营养方式对肝移植术后早期感染的影响[J/CD]. 中华移植杂志: 电子版, 2017, 11(4): 211- 215.
13 卢建军, 李恒爱, 熊莺, 等. 肝移植术后患者医院感染的流行病学特征[J].中华医院感染学杂志,2018,(23):3598- 3601.
14 吴晓峰, 林栋栋. 肝移植术后肺部感染的危险因素[J]. 北京医学, 2014, 36(9): 766- 769.
15 Siniscalchi A, Aurini L, Benini B, et al. Ventilator associated pneumonia following liver transplantation: Etiology, risk factors and outcome[J]. World J Transplant, 2016, 6(2): 389- 395.
16 Ikegami T, Shirabe K, Matono R, et al. Etiologies, risk factors, and outcomes of bacterial pneumonia after living donor liver transplantation[J]. Liver Transpl, 2012,18(9):1060- 1068.
17 Friedrich- Rust M, Wanger B, Heupel F, et al. Influence of antibiotic- regimens on intensive- care unit- mortality and liver- cirrhosis as risk factor[J]. World J Gastroenterol, 2016, 22(16): 4201- 4210.
18 Gao F, Ye Q, Wan Q, et al. Distribution and resistance of pathogens in liver transplant recipients with acinetobacter baumannii infection[J]. Ther Clin Risk Manag, 2015,11: 501- 505.
19 安玉玲, 傅斌生, 吕海金, 等. 肝移植术后早期优化气道湿化和雾化吸入方案的疗效分析[J/CD]. 中华移植杂志: 电子版, 2015, 9(4): 160- 164.