肝移植术后感染细菌学和耐药性及相关因素分析

目的总结肝移植病人术后细菌感染的规律，为防治感染提供依据。方法回顾性分析23例肝移植术后感染病人细菌学及耐药性资料，比较研究围手术期因素和感染发生的相关性。结果(1)术后感染病人最多见的病原菌依次为：金黄色葡萄球菌、铜绿假单胞菌、阴沟肠杆菌、大肠埃希菌、肠球菌；(2)病原菌多数多重耐药；(3)感染相关因素有：有无肝硬化(P=0．000)、术前白蛋白(P=0．026)、术前有无感染(P=0．026)、手术时间(P=0．014)、术中输红细胞量(P=0．000)、ICU住院时间(P=0．000)、呼吸机使用时间(P=0．012)；(4)背驮式和经典式肝移植术后肠道菌菌血症发生率不同(P=0．029)。结论肝移植术后感染的病原菌大多是有强耐药性的院内感染细菌，抗菌药物的经验性使用可选择头孢哌酮／舒巴坦、头孢吡肟、碳青霉烯和糖肽类抗菌药。

Bacteriological,drug-resistant and correlative analysis of infection after liver transplantation

Objective To summarize the rules of infection after liver transplantation and provide evidence for its prevention and treatment. Methods The bacterial, antibiotic-susceptibility and clinical data of 23 patients receiving liver transplantation in our hospital were retrospectively analyzed. Meanwhile, the relationship between bacterial infection and some perioperative factors was determined. Results 1) The most common pathogens for the infection were staphylococcus aureus, Pseudomonas aeruginosa, Enterobacter cloacae, Escherichia coli and Enterococcus and the infection took place in 1 month after liver transplantation in most of the patients. 2) Most of the pathogens were resistant to broad-spectrum antibiotics. 3) The factors being related to the infection included existence of cirrhosis, albumin level before transplantation, presence of infection before transplantation, duration of operation, volume RBC transfused during the operation, duration of staying in ICU and use of ventilator. 4) The recipients of piggy-back liver transplantation seemed to be easier to suffer from intestinal bacterial sepsis than those of orthotopic liver transplantation. Conclusions Most of the bacteria responsible for postoperative infection in recipients of liver transplantation are multi-drug resistant. Cefoperazone/sulbactam, cefepime, carbopenems and glycopeptides are better antibiotics for treatment of the infection.