泌尿系疾病患者感染标本中大肠杆菌耐药性的检测

目的监测泌尿系疾病患者感染标本中大肠杆菌耐药状况，为临床用药提供参考。方法回顾性分析2003年1—12月泌尿外科住院患者感染标本中分离的32株大肠杆菌对常用抗生紊耐药性的检测结果，其中，菌株来自尿液20株、分泌物4株、脓液4株、引流液2株、血液和精液各1株。结果临床常用的22种抗生素中，耐药率〉50％者10种，占45％。四环素的敏感率为0，氨苄西林、哌拉西林和萘啶酸的敏感率〈10％。敏感率）80％者为阿米卡星、亚胺培南、头孢他啶、呋喃妥因、头孢哌酮、头孢吡肟共6种，未发现亚胺培南耐药菌株。结论泌尿系统感染致病菌中大肠杆菌的耐药性严重，其中以应用历史长、范围广的口服类抗生素的耐药性最为严重。     

慢阻肺急性加重期的呼吸道病原菌及耐药性

目的：为掌握慢阻肺（COPD）急性加重期致病菌对一些抗菌药物的耐药情况,作为临床合理应用抗生素的依据,以期为临床治疗提供参考。方法：采用径口痰菌培养,用VITEK－ATB和API系统鉴定菌种,药敏采用纸片扩散法。结果：目前急性上呼吸道感染的主要致病菌群为革兰阴性杆菌（72．95）,其次为球感染（27．1％）。药敏结果表明,细菌耐药性严重;对革兰阴性杆菌耐药率依次为亚胺培南、头孢他啶、阿米卡 星;约70％葡萄球菌为苯唑西林耐药株,并对多种抗菌药物耐药,但对去甲万古霉素均敏感;肠杆菌属对庆大霉素、哌拉西林、环丙沙星耐药率增高显著,对阿米卡星耐药率低;不动杆菌属中对优力新、喹诺酮类耐药率低。结论：COPD急性加重期分离细菌对多种抗菌药物率有上升趋势。明确致病菌、合理应用抗生素剂量及疗程、减少耐药菌株有实际意义。     

肾结石合并尿路感染的菌谱及耐药性分析

目的探讨广州医科大学附属第一医院泌尿外科肾结石合并尿路感染的感染率、病原菌分布及耐药性,为临床合理用药提供依据。方法收集广州医科大学附属第一医院泌尿外科2009年1月至2016年12月肾结石合患者中段尿培养资料,统计并分析菌谱和耐药性的变化。结果从14 063份肾结石患者中段尿标本中分离致病菌3 280株,阳性率为23.3%。肾结石合并尿路感染主要致病菌为大肠埃希菌(47.13%),肺炎克雷伯菌(8.35%)、粪肠球菌(8.14%)、奇异变形杆菌(7.10%)和铜绿假单胞菌(4.97%)。大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌和奇异变形杆菌对阿米卡星、哌拉西林/他唑巴坦、亚胺培南耐药率≤10%,鲍曼不动杆菌对头孢吡肟、亚胺培南耐药率≥20.00%。粪肠球菌、屎肠球菌和凝固酶阴性葡萄球菌对万古霉素和替考拉宁的敏感率为100%。结论大肠埃希菌是肾结石患者合并尿路感染的主要致病菌,对青霉素类、喹诺酮类、第3代头孢菌素、磺胺类抗菌药物耐药率较高;对阿米卡星、β-内酰胺酶抑制剂复合制剂、亚胺培南等药物敏感。     

骨科感染病原菌谱与抗菌谱3年报告

[目的]了解骨科病人所感染菌群及其耐药性,指导临床正确应用抗生素。[方法]对骨科门诊及病房细菌感染病人的708份分泌物、脓液等标本进行需氧培养,并对检出菌按K-B法做体外药敏实验。[结果]检出致病菌259株,G 菌占47.9%,其中金黄色葡萄球菌33.0%,凝固酶阴性葡萄球菌14.9%;G-菌占52.1%,其中假单胞菌属占7.3%,不动杆菌属占6.1%。药敏显示革兰阳性球菌对青霉素及苯唑青霉素的耐药率逐年升高,对万古霉素的敏感性最高为100%。革兰阴性杆菌对亚胺培南的敏感率最高,3年平均95.8%,对头孢他啶也较敏感,但有逐年下降的趋势,对环丙沙星、阿米卡星、哌拉西林的耐药率较高,分别为46.0%、47.0%、51.2%。[结论]骨科病人感染的病原菌中,G-杆菌占大多数且有上升趋势,G 球菌感染发生率少于G-杆菌,单菌株以金黄色葡萄球菌占首位。对G-球菌可以选用万古霉素、苯唑青霉素、诺氟沙星等;对G-杆菌可以选用亚胺培南、头孢他啶。革兰阴性杆菌引起骨科感染有上升趋势,耐药也较严重,加强感染菌及药敏检测,合理使用抗生素非常必要。     

尿路感染病原菌分布及药敏分析

目的探讨尿路感染病原菌的分布及耐药性特征，为临床合理选用抗生素提供依据。方法收集146例尿路感染患者中段尿标本分离的病原菌进行鉴定及药敏实验。结果尿路感染革兰阴性菌感染占总体的67．8％，大肠埃希菌占56．1％，革兰阳性菌中，肠球菌占14．4％，葡萄球菌占13．7％，药敏显示，革兰阴性菌对亚胺培南、呋喃妥因、阿米卡星、二三代头孢敏感；革兰阳性菌对抗生素的敏感性以替考拉定、万古霉素最高。结论尿路感染应及时进行尿液细菌培养及药敏试验，慎重应用抗生素，以减少耐药株的产生。     

泌尿系统围手术期多重耐药菌感染的临床分析

目的分析围手术期泌尿系统多重耐药菌感染的尿细菌谱及其药物敏感实验结果,指导临床治疗。 方法回顾性分析我院自2013年1月至2016年12月154例患者围手术期清洁中段尿培养的多重耐药感染细菌谱和药物敏感实验结果报告。 结果154例多重耐药菌感染患者中革兰氏阴性菌有148例,占96.1%（148/154）,阴性菌中β-内酰胺酶（ESBLs）阳性145例,占97.97%（145/148）,阴性中大肠埃希菌127例,占第一位为82.47%（127/154）,其中ESBLs阳性125例,占98.43%（125/127）;革兰氏阳性菌有6例,其中屎肠球菌4例,溶血葡萄球菌2例。多重耐药菌在疾病分布中泌尿系结石占69.48%（107/154）,其次为泌尿系梗阻占21.43%（33/154）;人群分布中以中老年组最多,占80.52%（124/154）,青年组占15.58%（24/154）。对革兰氏阴性菌耐药率高的抗菌药分别是：羧苄西林、环丙沙星、头孢噻肟、复方新诺明,而敏感率较高的药物为：亚胺培南、阿米卡星、哌拉西林/他唑巴坦、呋喃妥因;革兰氏阳性菌敏感率高抗菌药为：亚胺培南、万古霉素,耐药率较高的药物为：羧苄西林、环丙沙星、头孢噻肟、复方新诺明、头孢他啶。 结论围手术期尿路多重耐药菌感染患者中以革兰氏阴性菌感染为主,其中又以大肠埃希菌最多,产生耐药性的主要原因为产生ESBLs。在进行经验性治疗时可选择对大肠埃希菌产ESBLs菌株敏感的抗菌药物进行治疗,并加强对抗菌药物使用的监测。     

耐左氧氟沙星大肠埃希菌的耐药性分析

目的了解本院临床分离的大肠埃希菌的耐药情况,分析耐左氧氟沙星细菌的耐药性。方法对2009年8月至2010年8月本院临床分离的154株大肠埃希菌用Kirby-Bauer琼脂扩散法进行药物敏感试验。结果 154株大肠埃希菌中共检出耐左氧氟沙星菌76株,检出率49.35%。在各类标本中,尿液中耐左氧氟沙星菌株分离率最高（51.32%）,其次为痰（23.68%）。除亚胺培南、美罗培南、头孢西丁、哌拉西林/他唑巴坦和阿米卡星外,耐左氧氟沙星菌株对氨苄西林、头孢唑啉、头孢吡肟、头孢噻肟、头孢他啶、庆大霉素、头孢哌酮/舒巴坦的耐药率明显高于非耐左氧氟沙星菌株（P〈0.05）。结论本院耐左氧氟沙星大肠埃希菌株对多种药物表现出较高的耐药率,应加强对耐左氧氟沙星大肠埃希菌的耐药性监测,严格掌握抗菌药物的使用指征,防止耐药菌株的传播流行。     

术后腹部感染的腹腔引流液细菌学分析

对本科三年间术后腹部感染的１００ 例腹腔引流液进行细菌培养和药物敏感试验分析,结果检出７７ 例病原菌阳性, 共分离出９７ 株菌株： 革兰氏阳性球菌３６ 株（３７．１％ ）, 革兰氏阴性杆菌５１ 株（５２．６％ ）, 酵母样真菌１０ 株（１０．３％ ）。肠球菌属列检出菌首位（２７．８％ ）, 以肠球菌合并其它菌群感染的占混合感染的９０．５％ 。抗生素敏感试验结果显示上述菌株具有高度耐药性： 革兰氏阳性球菌仅对万古霉素敏感（耐药率为２．８％ ）; 革兰氏阴性杆菌对头孢哌酮／舒巴坦、亚胺培南耐药率相对较低（分别为３１．４％ , ２７．５％ ）。说明： 外科医生在努力增强患者免疫功能和保持局部引流通畅的同时, 要时刻注意菌群的改变和耐药菌株的增加, 并及时调节抗生素的应用。     

胆囊切除术患者胆汁培养和药敏分析

目的 观察现阶段本中心胆囊切除术患者胆汁病原菌培养阳性率、菌株分布特征和对抗生素 的耐药性,以指导目前抗菌药物在胆道疾病中的合理应用。方法 选取2016年4月至2018年9月湛江市肿瘤医院普通外科诊断为胆囊结石伴急性胆囊炎、胆囊结石伴慢性胆囊炎、胆囊息肉伴慢性胆囊炎的患者 137例,行胆囊切除术,围手术期使用的抗生素主要为头孢孟多酯、头孢唑肟、头孢哌酮/舒巴坦+甲硝唑。 术后均留取胆汁标本,行胆汁细菌、厌氧菌和真菌培养,对病原菌培养和药敏结果进行分析。结果 137 例胆汁标本中62例培养出病原菌,阳性率45.3%,62株病原菌中革兰氏阴性菌22株（35.5%）,革兰氏阳性 菌37株（59.7%）,真菌 3株（4.8%）。排在第一位的菌株仍为大肠埃希菌。革兰阴性菌前2位为大肠埃希菌（10 株,16.2%）和肺炎克雷白杆菌（4株,6.5%）,革兰氏阳性菌前2位为粪肠球菌（9株,14.5%）和溶血葡萄球 菌（9株,14.5%）。药敏结果耐药性分析：革兰阴性菌对亚胺培南、美罗培南和哌拉西林/他唑巴坦的耐药 率最低（均为0）,其次为阿米卡星（4.7%）和头孢哌酮/舒巴坦（9.5%）。革兰氏阳性菌对万古霉素、利奈唑胺和阿米卡星耐药率最低（均为0）,其次为克林霉素（3.0%）、替考拉宁（3.1%）和左氧氟沙星（4.5%）。真菌对常见的抗真菌药两性霉素、氟康唑、伊曲康唑和伏立康唑未见有耐药。137例患者中有22例是胆囊息肉伴慢性胆囊炎,培养出病原菌7株,阳性率为31.8%。结论 本研究显示,胆囊切除术患者胆汁中的主要病原菌仍是大肠埃希菌,但胆汁培养中革兰氏阳性菌株占多数,可能原因为头孢类抗生素使用后革兰 氏阴性菌生长受到抑制以及革兰氏阳性菌感染近年来有上升趋势。胆囊结石伴急性胆囊炎患者术后可根 据临床经验选择抗生素治疗,而无手术条件患者行保守治疗首选哌拉西林/他唑巴坦或头孢哌酮/舒巴坦+ 甲硝唑,如果效果不佳可联用或改用克林霉素、万古霉素,或升级为亚胺培南、美罗培南治疗。胆囊息肉 伴慢性胆囊炎患者胆汁培养菌株阳性率较高,无症状胆囊切除术患者围手术期仍需使用抗生素。     

糖尿病肾病患者泌尿系统肠球菌多重耐药菌株感染状况和耐药性分析

目的：为了了解糖尿病肾病患者泌尿系统肠球菌感染状况和耐药情况,为临床治疗及防治糖尿病肾病泌尿系统肠球菌感染提供最新参考依据.方法：收集我院2009年-2013年糖尿病肾病患者泌尿系统感染中段尿培养出的肠球菌菌株并分析其耐药性.结果：中段尿培养检出120株肠球菌,粪肠球菌和屎肠球菌检出为主,分别66株（55.0%）、44株（36.7%）,从高到低依次为鸟肠球菌、母鸡肠球菌、铅黄肠球菌.粪肠球菌和屎肠球菌是糖尿病肾病患者泌尿系统感染肠球菌最常见的菌种.120株肠球菌中MDR菌株83株（69.2%）,其中氨基糖苷类高度耐药菌株HLAR多重耐药株64株（53.3%）,1株耐万古霉素VRE菌株.药敏表明：万古霉素和替卡拉宁的敏感度最高.粪肠球菌对氨苄西林、青霉素和呋喃妥因的敏感度较高;而屎肠球菌刚相反敏感率较低.结论：糖尿病肾病患者肠球菌MDR菌株感染严重,多重耐药对临床治疗带来不利,临床应注重病原菌的检测,根据药敏结果合理选择药物,延缓和控制耐药菌的产生.     

Diagnosis and management of BK polyomavirus interstitial nephritis in renal transplant recipients

BACKGROUND: Interstitial nephritis caused by BK polyomavirus is a recognized complication of renal transplantation. A study of renal transplant recipients at Duke University Medical Center was undertaken to evaluate diagnostic modalities and assess clinical outcomes in transplant polyomavirus infections. METHODS: Polyomavirus nephritis was identified in 6 of 240 patients who received renal transplants between January 1996 and June 1998 and an additional patient who underwent transplantation in 1995. The clinical records of these seven patients were reviewed, as were all renal biopsy and nephrectomy specimens. Electron microscopy (EM) was performed on negatively stained urine samples from 6 patients with polyomavirus infection and 23 patients with other diagnoses. RESULTS: Patients with polyomavirus infection shared several clinical features, including ureteral obstruction (5/7 patients), lymphocele (3/7), bacterial urinary tract infection (3/7), hematuria (3/7), cytomegalovirus infection (3/7), and immunosuppression with mycophenolate mofetil (6/7). All patients experienced elevations in serum creatinine, which stabilized or decreased in four patients with altered or decreased immunosuppression. The diagnosis of polyomavirus infection was established by renal biopsy and EM of urine in five patients, by biopsy alone in one, and by EM alone in one. Sequential examinations of urine by EM were used to monitor the course of infection in six patients. CONCLUSIONS: Interstitial nephritis due to BK polyomavirus occurred in 2.5% of patients receiving renal transplants at our center since 1996. Polyomavirus infection can cause transplant dysfunction and graft loss, but progression of the infection can frequently be abrogated with alterations in immunosuppressive therapy. Both renal biopsy and EM of urine samples are useful in the diagnosis and monitoring of polyomavirus infections.     

Stool cultures obtained before liver transplantation are useful for choice of perioperative antibiotic prophylaxis

Bacterial infections, especially cholangitis, are still common complications after liver transplantation (LTx). During recent years, multiresistant enterococci have become a nosocomial problem in transplant units. The present prospective study on 26 patients, including 24 patients with chronic liver disease, demonstrated that enterococci were the predominant micro-organism involved in post-LTx bacterial infections. They were cultured in the feces and in other sites of 10 out of 13 (77 %) patients who underwent extensive examinations. Ampicillin-resistant Enterococcus faecium strains were isolated in urine or feces of 2 of the 13 patients prior to LTx. Similarly, resistance to ampicillin and gentamicin, the empirically used antibiotics for patients with fever of unknown origin, was found in E. faecium strains in 3 and 2 patients, respectively. Moreover, multiresistant E. faecium and E. faecalis strains were demonstrated in 46 % of the patients in the postoperative period (3 months). However, no vancomycin-resistant enterococci were isolated. The use of antibiotics within 4 months prior to LTx significantly increased the risk of developing ampicillin-resistant bacteria at the time of LTx and of infections with bacteria of enteric origin after LTx (P = 0.03 and 0.01, respectively). We conclude that stool and urine cultures performed prior to LTX may be useful for selecting prophylactic antibiotic regimens. Received: 13 November 1996 Received after revision: 23 April 1997 Accepted: 30 June 1997     

Epidemiology and outcomes of multiple antibiotic-resistant bacterial infection in renal transplantation

BACKGROUND: Mutiresistant bacterial infections are an emerging problem in the nosocomial setting. Our objectives were to describe the incidence, outcome, and risk factors for acquisition of multiresistant bacteria among renal transplant recipients. METHODS: We prospectively followed patients undergoing kidney transplantation over a 3-year period. We collected demographic features, underlying chronic diseases, and main transplant characteristics and complications. Multiple antibiotic resistance was defined for the most important bacteria: Enteric gram-negative bacilli resistant to betalactamics, cephalosporins, and quinolones; Staphylococcus aureus resistant to methicillin, cotrimoxazole, and clindamcin; Enterococcus spp resistant to ampicillin and quinolones; nonfermentator bacilli resistant to all antibiotics except aminoglycosides and collistin. RESULTS: Overall, 416 patients included 65 double transplants (62 kidney-pancreas and three kidney-liver) of mean age 48.5 years, and 57% men. Infection with multiresistant bacteria was observed in 58 patients (14%). Most frequent multiresistant bacteria were: Escherichia coli (n = 33), Klebsiella spp (n = 15), Citrobacter spp (n = 8), Enterobacter spp (n = 5), Morganella morganii (n = 2), Pseudomonas aeruginosa (n = 16), Acinetobacter baumanii (n = 2), Enterococcus spp (n = 9) and methicillin-resistant S. aureus (MRSA, n = 2). Age greater than 50 years, hepatitis C virus infection, double kidney-pancreas transplantation, requirement for posttransplant hemodialysis, surgical reoperation, and requirement for nephrostomy were independent variables associated with multiresistant bacterial infection. Most used antibiotics for treatment were: carbapenems (65%), amikacin (12%), linezolid, piperacillin-tazobactam, vancomycin, collistin, and fosfomycin. Infection with multiresistant bacteria was associated with a worse prognosis (graft loss or death, 19% vs 8%, P = .009). CONCLUSIONS: The incidence of infection with multiresistant bacteria in our renal transplant cohort was high, being most frequently cephalosporin-resistant enteric gram-negative bacilli and multiresistant P aeruginosa. Methicillin-resistant S. aureus incidence was low. Infection with multiresistant bacteria conferred a worse prognosis.     

Various Aspects of Bacterial Infections in the Early Postoperative Stage Among Lung Transplant Recipients on Broad-Spectrum Antibiotics: A Single Center Study

BackgroundLife-long immunosuppression after lung transplantation increases the risk of bacterial infections, hence broad-spectrum antibiotics can be implemented after transplant. The aim of this study is to assess various aspects of bacterial infections in the early postoperative stage among lung transplant recipients on broad-spectrum antibiotics at a single center.MethodsThis retrospective study consists of 134 primary lung transplant recipients transplanted between 2014 and 2021 at a single center. Study analyzed the occurrence of de novo bacterium in bronchoalveolar lavage sampled 2 to3 weeks after lung transplantation, as well as survival and the occurrence of bacterial sepsis. Studied antibiotics include linezolid, meropenem, tobramycin, and cloxacillin.ResultsNone of the patients from the broad-spectrum antibiotics developed bacterial sepsis within the first 30 postoperative days. In-hospital mortality due to bacterial sepsis among patients in the broad-spectrum group was 1.89%. The most common new pathogen in first couple of days after lung transplantation was Burkholderia multivorans (42%). After its occurrence, Ceftazidime was administered. It significantly reduced the occurrence of hospital-acquired B multivorans after 2 to 3 weeks post-transplant (χ² = 8.01, P = .005).ConclusionBroad-spectrum antibiotics seem to be an efficient approach against bacterial infections for lung transplant recipients in the early post-transplant period, as patients treated this way very rarely develop fatal bacterial infections in the studied period. Ceftazidime proved efficient for treatment for B multivorans among the studied group. Patients, who acquired new pathogen during post-transplant hospital stay presented comparable lung function at discharge in comparison to those who were not.     

Nosocomial infection in kidney transplant recipients: a retrospective analysis of a single-center experience

Posttransplant bacterial infections are important because of their influence on patient and graft outcomes. Therefore, prevention of infection as well as prompt diagnosis and appropriate treatment are crucial. In this retrospective analysis, we reviewed all posttransplant bacterial infections occurring during the admission of kidney transplant patients from January 2000 to May 2004. Of our patients, 25% had at least one episode of infection. Patients with immunosuppression based on an mTOR inhibitor showed the highest rate of wound infections compared to those receiving a calcineurin inhibitor (odds ratio 5.6, P < .001). Patients with renal failure caused by a urologic disease revealed a increased risk of a urinary tract infections (odds ratio 5.9, P < .001). Although infection complications are an important cause of morbidity in renal transplantation, the extensive use of antibiotics should be avoided in favor of a strict policy for infection prevention and control.     

Bladder content and residual urine in renal transplant patients: measurement using ultrasonography and relevance to urinary tract infection

Summary Since the incidence of urinary tract infection after renal transplantation is high, and residual urine after voiding may be associated with urinary tract infection, the reliability of ultrasonographic determination of bladder content and residual urine in renal transplant recipients was investigated. Both bladder content and residual urine, calculated by the formula 0.6 × length × width × depth of the bladder (in cm), correlated closely (r>0.9, P<0.001) to the measured volumes of urine obtained by voiding and catheterization. We conclude that ultrasonography is a reliable method for determining bladder content and residual urine in renal transplant recipients. Out of 44 patients, 4 exhibited residual urine of more than 10 cm³; 25 of the 44 patients (57%) had one or more urinary tract infections within the first year of transplantation. One of the patients with residual urine had recurrent pyelonephritis and another had recurrent cystitis; the other two patients did not have any urinary tract infection at all. Since residual urine does not appear to be a frequently occurring phenomenon, it probably does not contribute to the high incidence of urinary tract infections in renal transplant recipients.     

Diagnosis and treatment of infection in cardiac transplant patients

Despite major advances in the management of rejection and the development of newer and more potent antimicrobials, infection still constitutes a major problem in transplant patients and other immunosuppressed hosts. Infectious complications in transplant patients clearly occur in two phases. The first phase includes the first 30 to 60 days after transplantation. During this period, nosocomial bacterial infections are most commonly encountered. Pulmonary, renal, and wound infections have all been encountered, and prophylactic antibiotics appear to decrease their frequency. Opportunistic infections usually do not occur during this period unless the patient undergoes treatment for acute rejection. The second phase of infectious complications usually follows the first month after transplantation. In this period, the level of immunosuppression is high, and opportunistic infections are common. Opportunistic pulmonary infections caused by P. carinii, L. pneumophila, cytomegalovirus, Aspergillus, and Nocardia spp. all are potentially life-threatening complications to the transplant patient. Aggressive diagnostic tests such as bronchoscopy, percutaneous needle biopsy, or open lung biopsy are frequently needed to make a diagnosis. Empiric broad-spectrum antimicrobial therapy is indicated in the ill patient; however, more specific therapy should be instituted once the diagnosis is confirmed.     

胆道手术患者胆汁培养和药物敏感分析的临床研究

目的 分析胆道疾病患者胆汁致病菌的分布特点及耐药情况,以便合理选择抗生素.方法 抽取2007年6月至2008年3月在上海交通大学医学院附属仁济医院普外科行胆道手术的195例患者的术中胆汁,并选取24名健康人作为对照,进行细菌培养及药物敏感试验.结果 195例胆道疾病患者胆汁培养阳性率为22.6%(44/195),其中混合感染率为25.0%(11/44).培养菌株55株,菌种16种,其中G-菌占61.8%(34/55),C+菌占34.6%(19/55),真菌占3.6%(2/55).主要致病菌为大肠杆菌(27.3%)、阴沟肠杆菌(12.7%)、粪肠球菌(12.7%)、屎肠球菌(10.9%).24名健康人正常胆汁培养阳性率为4.2%(1/24),为大肠杆菌.药物敏感实验结果显示:G-菌对美洛培南总耐药率最低(2.8%),其次为亚胺培南(5.6%)、头孢哌酮/舒巴坦(22.8%)、阿米卡星(28.7%).对青霉素类、喹讲酮类、部分三代头孢菌素类等抗生素耐药率较高(>50.0%).G+菌对万古霉素、替考拉宁总耐约率为0.对青霉素类、喹诺酮类、克林霉素等抗生素耐药率较高(>40.0%).结论 (1)该院胆道感染以G-菌为主,主要致病菌为大肠杆菌,肠球菌有上升趋势.细菌混合感染多见于急性感染患者.(2)治疗胆道感染首选对大肠杆菌耐药率低的广谱抗生素.头孢他啶、环丙沙星可用于胆道轻度感染,中重度感染首选头孢哌酮/舒巴坦或阿米卡星,亚胺培南、万古霉素可作为临床二线用药治疗其他药物治疗无效的感染.     

心脏移植受者术后感染的防治

通过临床分析３例心脏移植受者在术后不同阶段所发生的各种感染性疾病，主要探讨心脏移植术后感染发生的规律及其防治措施。结果发现在术后１－２个月，细菌性感染及机会性真菌感染较多见，采用敏感的抗生素能够完全控制感染。术后３个月以上的患者，各种感染逐渐减少。提示在移植术后初期，应加强对感染的监测与防治。     

Probiotic use in preventing postoperative infection in liver transplant patients

Background

Although liver transplantation has been widely practised, post-operative bacterial infection is still a frequent complication which contributed to an increased risk of fatality. There were studies on preoperative use of probiotics for liver transplant patients and acquired reduction in postoperative sepsis and wound infection, but the relevant clinical experience with pre- and probiotics is still limited.

Objectives

This study is to assess fibre and probiotic use aimed at preventing bacterial sepsis and wound complications in patients undergoing liver transplantation.

Study methods

There were a total of sixty-seven adult patients scheduled for liver transplantation were included in a public teaching hospital. From January to December 2011, 34 continuous patients following liver transplantation were put on fibre + probiotics. In retrospectively, from January to December 2010, 33 continuous patients were collected as a control group and they were only received fibre post operation. The incidence of bacterial infections was compared in patients receiving either fibre and lactobacillus or fibre only. Statistical analysis was performed using SPSS 15. The t test, fisher’s and chi- square test was used to compare discrete variables.

Results

In summary, in the analysis of 67 liver transplant recipients, 8.8% group A patients developed infections compared to 30.3% group B patients. The difference between groups A and B was statistically significant in both cases. In addition, the duration of antibiotic therapy was significantly shorter in the lactobacillus-group. Wound infection was the most frequent infections and enterococci the most frequently isolated bacteria. Fibre and lactobacilli were well tolerated in most cases. The operating time, amount of intra- and post-operatively transfused units of blood, fresh frozen plasma and albumin did not differ significantly between the groups.

Conclusions

Combined fibre and probiotics could lower the incidence of bacterial infections and shorten the duration of antibiotic therapy following liver transplantation in comparison to conventional nutrition. In contrast to antibiotics, it is relatively cheap and does not cause resistant strains or serious side effects.Key Words: Liver transplantation, probiotics, bacterial infection