86例肝移植术后早期细菌感染患者的细菌类型及耐药性分析

目的：探讨肝移植术后早期肺部并发症的临床特点及危险因素,为临床防治提供参考和依据。方法：回顾性分析本院2004年8月至2009年12月所施行的163例肝移植患者中细菌感染病例,通过细菌培养鉴定及药敏试验分析细菌感染特点。结果：86例患者术后发生细菌感染,共分离出166株病原菌,患病率为52.7%。感染部位主要发生在呼吸道（68.2%）,其次为血夜（9.6%）和中段尿（8.4%）,感染主要发生在术后1月内,前两周最常见（81.9%）。感染的细菌中G-菌76株（46.2%）,G＋菌68株（39.3%）,真菌24株（14.5%）,其中以鲍曼氏不动杆菌、肺炎克雷伯菌、大肠埃希氏菌、溶血葡萄球菌、金黄色葡萄球菌常见（53.2%）。其中40例病人合并两种以上病原菌感染。碳青霉烯类和氨基糖苷类、恶唑烷酮类分别对G-菌和G＋菌高度敏感。结论：细菌感染是肝移植术后早期常见的并发症,临床上应加强肝移植术后患者细菌的鉴定和耐药监测,争取合理选用抗菌药物。

Analysis of epidemiology and drug resistance of bacterial infection during the early postoperative period in liver transplantation

AIM：To investigate epidemiology and drug resistance associated with bacterial infection during early postoperative period after liver transplantation in the purpose of prevention and treatment.METHODS：Altogether 163 recipients of liver transplantation admitted from Apr.2004 to Dec.2009 in Nanfang Hospital were studied retrospectively and identified the bacterial and drug resistance.RESULTS：Bacterial infections occurred in 86 cases（52.7%）and 166 strains separated from various specimens.The main sites for pathogens were respiratory tract（68.2%）,then blood（9.6%） and urine（8.4%）.Main infections developed in the first month,especial in the front two weeks（81.9%）.The strains bacteria included 76G-strains（46.2%）,68 G＋ strains（39.3%） and 24 fungi strains（14.5%）.The most commom were strains Acinetobacter Baumannii,Staphylococcus haemolysis,Klebsiella pneumoniae,Staphylococcus aureus,Bacillus coli（53.2%）.There were 46 patients suffered from mixed bacterial infection.Most of the G-bacteria were sensitive to carbapenems;G＋ bacteria were sensitive to aminoglycosides and oxazolinones.CONCLUSION：The infective complications are common in patients with live transplantation an the early stage,it is important to identify the bacteria and drug resistance for the purpose of prophylaxis and treatments.