肝移植后受体真菌感染的易感因素分析

目的了解肝移植后受体发生真菌感染的病原菌种类,分析相关易感因素,并探讨其预防措施. 方法回顾性分析我院器官移植中心从1993年4月～2001年12月收治的102例成年肝移植患者. 结果 102例成年肝移植患者共做106次原位肝移植术,有22例患者共分离出26株真菌,感染率为21.6%,其中13例为白色念珠菌感染(59.1%),6例为光滑念珠菌(27.3%),5例为热带念珠菌(22.7%),1例为季也蒙念珠菌(4.5%),1例为曲霉菌(4.5%),感染部位以呼吸道为主(占42.9%);肝移植术后真菌感染与患者手术后胃肠外营养时间、呼吸机使用时间以及患者总住院时间有明显相关性(P<0.05);术后预防性应用抗真菌药的患者与无预防性用药的患者的真菌发生率差异无显著性(P>0.05). 结论真菌感染是肝移植术后的重要并发症,病原菌以白色念珠菌为主,患者手术后胃肠外营养时间和呼吸机使用时间是真菌感染的易感因素,真菌感染后住院时间延长,预防性抗真菌治疗措施有待进一步改善.

Fungal Infection in Liver Transplant Recipients: An Analysis of Risk Factors

OBJECTIVE To identify the most common fungal pathogens, determine the risk factors of fungal ~infections in liver transplant recipients, and to discuss the way to prevent fungal infection. METHODS A ~retrospective study of all adult patients who had been performed orthotopic liver transplantation operation from Apr 1993 to Dec 2001 in the First Affiliated Hospital of Sun Yat-sen University, was carried out. RESULTS One hundred and six orthotopic liver transplantation operations were performed in 102 patients. Totally 26 fungi strains were isolated in 22 patients and the infection rate was 21.6%. Among them 13 cases were infected by Candida albicans (59.1%), 6 cases by C. glabrata (27.3%), 5 cases by C. tropicalis (22.7%), 1 case by ~C. guilliermondii (4.5%), and 1 case with Aspergillus (4.5%). The main site of fungal infection was the ~respiratory tract (42.9%). The length of time in parenteral nutrition (TPN), duration of ventilation and total hospital stay were correlated with fungal infection after liver transplantation (P<0.05). The infection rate was not significantly different between patients with and without antifungal prophylaxis (P>0.05). CONCLUSIONS A major complication after liver transplantation is fungal infection, among which C. albicans is the main fungal pathogen. The length of time in parenteral nutrition and duration of ventilation are the risk factors of fungal ~infection in liver transplant recipients. And total hospital stay will be prolonged when complicated with fungal ~infection. Antifungal prophylaxis needs to be improved.