直肠拭子培养对肝移植受者耐碳青霉烯类肺炎克雷伯菌血流感染的预警价值

目的探讨肝移植受者直肠拭子培养耐碳青霉烯类肺炎克雷伯菌(CRKP)阳性对CRKP的血流感染的预警价值,寻找受者CRKP血流感染的危险因素并提供相关的治疗方案。方法对2018年6月至2019年12月华中科技大学同济医学院附属同济医院进行肝移植的148例受者进行直肠拭子培养,对直肠拭子培养CRKP阳性的受者的临床资料进行回顾性分析,分析CRKP血流感染相关的危险因素,根据是否给予干预治疗分为干预组和未干预组,观察干预治疗对CRKP的血流感染的干预效果。结果148例肝移植受者进行直肠拭子培养检出CRKP阳性23例(15.5%),发生CRKP血流感染5例(21.7%,5/23);直肠拭子培养阴性125例,均未发生血流感染。长期使用广谱抗菌药物、严重的基础疾病(重症肝炎)、术后移植肝功能恢复延迟、急性肾功能衰竭需要肾替代治疗(RRT)、术后抗人胸腺细胞免疫球蛋白(ATG)的诱导均是直肠拭子培养CRKP阳性的受者发生CRKP血流感染的危险因素。此外,干预组中18例直肠拭子培养CRKP阳性的受者后期发生CRKP血流感染者2例(11.1%);未干预的5例CRKP阳性的受者后期发生CRKP血流感染者3例(60%)。干预组血流感染的发生率明显低于未干预组(P<0.05)。结论对肝移植受者进行直肠拭子培养可为CRKP血流感染提供预警,对直肠拭子培养CRKP阳性的高危受者进行干预治疗,可以减少CRKP血流感染的发生。

Early warning value of positive rectal swab culture for bloodstream infection of carbapenem-resistant Klebsiella pneumoniae in liver transplant recipients

Objective To explore the early warning value of carbapenem-resistant Klebsiella pneumoniae(CRKP)positivity in liver transplantation recipients with rectal swabs,examine the risk factors of CRKP bloodstream infection and provide the relevant treatments.Methods From June 2018 to December 2019 in Organ Transplantation Research Institute Affiliated Tongji Hospital Tongji Medical College Huazhong University of Science&Technology,148 cases of liver transplantation recipients with positive CRKP rectal swabbing were recruited.Clinical data were retrospectively analyzed.And the risk factors of CRKP bloodstream infections were examined for intervention and non-intervention groups to observe the effect of interventions of CRKP bloodstream infections.Results Among them,23 cases(15.5%)were positive for CRKP and 5 cases(21.7%)were infected with CRKP bloodstream.Rectal swab culture was negative in 125 cases and no bloodstream infection occurred.Long-term use of broad-spectrum antimicrobial agents,severe basic diseases(severe hepatitis),postoperative delayed graft liver function recovery,acute renal failure requiring renal replacement therapy(RRT)and postoperative anti-thymocyte globulin(ATG)induction were risk factors.In intervention group,there were 2 cases(11.1%)of 18 patients with positive CRKP in rectal swab culture in late stage.Among 5 CRKP-positive recipients without intervention,3 cases(60%)developed later CRKP bloodstream infection.The incidence of bloodstream infection was significantly lower in intervention group than that in non-intervention group(P<0.05).Conclusions Rectal swab culture for liver transplantation recipients provides early warning for CRKP bloodstream infection.Interventions for CRKP positive high-risk recipients with rectal swab culture may reduce the occurrence of CRKP bloodstream infection and lower the risk of CRKP bloodstream infection in liver transplantation recipients.