心脏死亡器官捐献肾移植受者术后医院感染目标性监测

目的探讨心脏死亡器官捐献(DCD)肾移植受者术后医院感染发病率及病原体分布,为制定相应预防和控制措施提供理论依据。方法采用前瞻性研究方法对某三级医院2014年1月—2016年12月DCD肾移植受者进行医院感染目标性监测,分析DCD肾移植受者术后医院感染的发病率、医院感染病原学特点。结果 2014年1月—2016年12月共监测DCD肾移植患者313例,其中发生医院感染患者48例,共63例次,医院感染发病率为15.34%,例次发病率为20.13%。2016年DCD肾移植受者术后医院感染发病率为10.11%(19/188),2014年为28.57%(14/49),2015年为19.74%(15/76),各年份医院感染发病率比较,差异有统计学意义(P0.05)。居前三位的医院感染部位分别为下呼吸道(22/63,34.92%)、手术部位(16/63,25.39%)及血液系统(11/63,17.46%)。共检出病原体42株,主要为革兰阴性菌(27株,64.29%),其次是真菌(9株,21.43%)和革兰阳性菌(6株,14.28%);居前三位的病原体依次为肺炎克雷伯菌(9株,21.43%)、热带假丝酵母菌(7株,16.67%)、大肠埃希菌(5株,11.90%)。42株病原体中多重耐药菌(MDRO)15株(35.71%),其中革兰阴性菌10株(66.67%),以耐碳青霉烯类肠杆菌科(4株)及不动杆菌属(3株)为主;革兰阳性菌5株(33.33%),以耐甲氧西林金黄色葡萄球菌(3株)为主。结论 DCD肾移植受者术后医院感染发病率较高,应采取综合干预措施加强对下呼吸道感染、手术部位感染及血流感染的预防和控制,同时加强对MDRO感染的预防和控制,改善抗菌药物使用策略降低碳青霉烯类耐药菌株的产生。

Targeted monitoring on healthcare associated infection in donation after cardiac death kidney transplant recipients

ObjectiveTo explore the incidence and pathogens causing healthcare associated infection(HAI) in donation after cardiac death(DCD) kidney transplant recipients, provide theoretical basis for formulating corresponding prevention and control measures. MethodsTargeted monitoring on HAI in DCD kidney transplant recipients from January 2014 to December 2016 was studied prospectively, incidence and pathogenic characteristics of HAI in DCD kidney transplant recipients were analyzed. ResultsFrom January 2014 to December 2016, 313 DCD kidney transplant recipients were monitored, 63 patients had 48 times of HAI, HAI rate and HAI case rate were 15.34% and 20.13% respectively. HAI rate in 2016, 2014, and 2015 were 10.11%（19/188）， 28.57%（14/49），and 19.74%（15/76）respectively, HAI rates were statistically significant among different years（P＜0.05）. The top three infection sites were lower respiratory tract (22/63, 34.92%), surgical site (16/63, 25.39%), and blood system (11/63, 17.46%). A total of 42 strains of pathogens were isolated, mainly gram negative bacteria (n=27, 64.29%), followed by fungi (n=9, 21.43%) and gram positive bacteria (n=6, 14.28%); the top three pathogens were Klebsiella pneumoniae (n=9, 21.43%), Candida tropicalis (n=7, 16.67%), and Escherichia coli (n=5, 11.90%). Among 42 strains of pathogens, 15(35.71%) were multidrug resistant organisms(MDROs), 10(66.67%) of which were gram negative bacteria, mostly were carbapenem resistant Enterobacteriaceae(n=4) and Acinetobacter spp.(n=3); 5 strains (33.33%) were gram positive bacteria, mainly were methicillin resistant Staphylococcus aureus(n=3). ConclusionHAI incidence in DCD kidney transplant recipients is high, comprehensive intervention measures should be taken to strengthen prevention and control of lower respiratory tract infection, surgical site infection, and bloodstream infection. Prevention and control of MDRO infection should be strengthened, antimicrobial use strategy should be improved to reduce the emergence of carbapenem resistant strains.