86例肝移植术后抗菌素使用的合理性分析

目的 分析肝移植术后细菌性感染的特征、抗菌素使用与细菌性感染之间的关系,评价肝移植术后抗菌素使用的合理性,探讨预防高水平耐药细菌性感染的措施. 方法回顾性分析86例肝移植术后感染的主要病原菌、抗菌素使用量,采用限定日剂量、用药频度、药物利用指数评价抗菌素使用的合理性,运用三维试验检测革兰阴性杆菌产超广谱β-内酰胺酶、AmpC β-内酰胺酶情况.结果 肝移植术后感染主要病原菌为粪肠球菌、阴沟肠杆菌、真菌,大肠杆菌,术前抗菌素使用率为83.7%,以单一抗菌素使用为主,术后抗菌素使用率达100.0%,以二联、三联抗菌素使用为主,抗菌素使用量居前3位为头孢菌素、含酶抑制剂复合抗菌素与青霉素类抗菌素,药物利用指数大于1.1的抗菌素包括氨苄西林、替考拉林,革兰阴性杆菌产超广谱β-内酰胺酶、AmpCβ-内酰胺酶分别为43.3%,31.8%,同时产两种酶的细菌占21.3%. 结论肝移植术后细菌性感染发生率高,抗菌素使用量大,频率高,抗菌素使用基本合理,易发生高耐药性细菌性感染,预防高耐药性细菌性感染十分重要.

Analysis of antibiotics treatment in 86 cases of liver transplant recipients

Objective To analyze the characteristic of bacterial infections, and the relationship between antibiotics treatment and bacterial infections after liver transplantation, and to prevent antibiotic-resistant bacterial infections. Methods 86 liver transplant recipients were retrospected. Different indexes including limited daily dose, the frequency of medication, drug use index were used to evaluate the rationality of the use of antibiotics, three-dimensional test was used to explore extended-spectrum beta-lactamase andAmpC enzyme of Gram-negative bacteria. Results The major pathogens of infection after liver transplanta-tion were Enterococcus faecalis, Enterobacter cloacae, fungi and E. coli Pre-operative antibiotic utilization rate was 83.7%, it was mainly a single use of antibiotics; After-operative antibiotic usage was 100.0%, it was mainly joint use of two or three antibiotics; The top 3 antibiotics used were cephalosporins, the combined enzyme inhibitors and penicillin. Antibiotics with drug utilization index (DUI) more than 1.1 included ampi-cillin and Lalin proxy. 43.3% and 31.8% of Gram-Negative bacteria produced ESBLs and AmpC, respectively,while 21.3% Gram-Negative bacteria produced two enzymes. Conclusion There is high incidence of bacterial infections after liver transplantation. The use of antibiotics is high dose, high-frequency and reasonable;High resistance of bacterial infections was prone to develop and the prevention of the high resistance of bacterial infections is very important.