肝移植术后受体ICU真菌感染的临床分析

目的：探讨导致原位肝移植术后重症监护病房（ICU）真菌感染的病原学特征和临床高危因素．方法：回顾我院2000-11／2006-01施行的102例次原位肝移植临床资料，对可能导致术后真菌感染的围手术期相关因素进行分析，筛选临床高危因素．结果：肝移植术后平均ICU留住时间为11．0d（7～23d），其间真菌感染的发病率为16％（16／102），平均发病时间为术后11．8d（6～18d）．主要致病菌为白色念珠菌，约占75％，发生部位以肺部（73％）和血液（19％）多见．多因素Logistic回归分析显示术前UNOS评分、术后中心静脉导管留置时间以及术后细菌、病毒等其他感染是诱发肝移植术后受体真菌感染的高危因素．结论：真菌感染是发生于肝移植术后ICU内重要并发症．白色念珠菌是最常见的致病菌．针对以上高危因素及早采取合理、有效的防治措施是减少ICU真菌感染的关键．

Clinical analysis of fungal infections in liver transplant recipients in ICU

AIM: To study the fungal spectrum and high risk factors associated with fungal infection in the intensive care unit (ICU) after orthotopic liver transplantation (OLTx). METHODS: One hundred and two consecutive OLTx in 100 recipients performed from November 2000 to January 2006 were included in the study. Their pre-surgical,surgical and post-surgical variables were retrospectively evaluated using multivariate logistic regression model to identify the significant risk factors. RESULTS: The mean ICU stay was 11.0 d (7-23 d). Out of the 102 OLTx,16 (16%) developed 29 positive cultures in our ICU and the mean time interval from transplantation to the deve- lopment of fungal infection was 11.8 d (6-18 d). The most common pathogen was Candida albicans (75%) and the common primary sites were the lungs (73%) and blood (19%). The risk factors for fungal infections included preoperative UNOS status,postoperative detained central venous catheter and other infective complications. CONCLUSION: Fungal infections are a major complication in ICU following OLTx,with Candida albicans being the most common pathogen. Surveillance for the high risk factors and earlier antifungal prophylactic treatment is the key to decrease the incidence of postoperative fungal infections.