肾移植受者围手术期医院感染发生及危险因素分析

目的 分析肾移植受者围手术期医院感染的发生情况及危险因素.方法 回顾性分析中山大学附属第一医院2000年1月至2009年8月992例肾移植受者围手术期医院感染的发生率、类型及危险因素等.结果 368例肾移植受者围手术期共发生医院感染499例次,发生率为37.1%（368/992）.主要感染类型包括CMV感染（234例次,46.9%）、手术部位感染（123例次,24.6%）、下呼吸道感染（80例次,16.0%）和尿路感染（36例次,7.2%）.尸体肾移植受者医院感染发生率高于亲属活体肾移植受者（40.9%与19.7%,X2=28.254,P〈0.05）.免疫诱导组受者医院感染发生率高于无诱导组（38.3%与14.3%,X2=11.461,P〈0.05）.术后应用以环孢素或他克莫司为基础的免疫抑制方案受者间医院感染发生率差异无统计学意义（P〉0.05）.急性排斥反应组受者医院感染发生率高于未发生急性排斥反应组（50%与31.2%,X2=32.172,P〈0.05）.围手术期医院感染危险因素包括：供肾类型（P〈0.05）、受者年龄（P〈0.05）、体质量（P=0.025）、住院时间（P=0.038）、移植术前或术后糖尿病（P〈0.05）、导尿管留置时间（P〈0.05）、切口引流管留置时间（P〈0.05）、预防性使用青霉素（P〈0.05）、术前血液透析时间（P=0.002）和急性排斥反应（P〈0.05）.结论 肾移植术后围手术期医院感染的发生率较高.CMV感染、手术部位感染和下呼吸道感染是肾移植受者围手术期最常见的医院感染类型.供肾类型、受者基础情况、手术技术及抗感染治疗等均是肾移植围手术期医院感染的危险因素.

Analysis on the incidence and risk factors of nosocomial infections in renal transplant patients during the perioperative period

Objective To determine the rate of nosocomial infections and risk factors in renal transplant recipients during the perioperative period. Methods A retrospective analysis was carried out in 992 patients who received kidney transplantation in the First Affiliated Hospital of Sun Yet-sen University from January 2001 to August 2009. The incidence, types, and risk factors of infective complications were analyzed. Results Out of 992 recipients, 368 had nosocomial infectious episodes （37. 1% ）. The nosocomial infections diagnosed during the perioperative period included CMV infections （234, 46.9% ）, surgical site infections （SSI, 123, 24.6% ）, lower respiratory infections （LRI, 80,16.0% ）, and urinary tract infections （ UTI, 36, 7.2% ）. The incidence of nosocomial infection of deceased donor recipients was higher than that of living donor recipients （40. 9% vs 19. 7% , %2 = 28. 254, P 〈 0. 05 ）. The incidence of nosocomial infection of patients receiving induction was higher than that of those not receiving induction therapy （ 38.3% vs 14.3% , 2 ：