肝移植患者术后感染病原菌的分布和耐药性分析

目的 分析我院肝移植患者术后感染病原菌分布及药敏情况，为临床治疗提供参考。方法 对我院174例肝移植患者感染情况作回顾性分析，细菌的鉴定及药敏采用Microscan Walkaway 40全自动系统。结果 59．8％肝移植患者发生术后感染，部分为混合感染。感染部位包括呼吸道、胆道、血液及腹腔等。分离数居前5位的细菌是鲍曼不动杆菌、金葡菌、铜绿假单胞菌、嗜麦芽窄食单胞菌和大肠埃希菌。分离到的革兰阴性菌对多种抗菌药物有不同程度耐药，对哌拉西林-三唑巴坦及亚胺培南耐药率相对较低。金葡菌绝大多数为耐甲氧西林菌株，仅对复方磺胺甲嗯唑及万古霉素敏感度较高。结论 肝移植患者术后感染病原菌常为多重耐药株，病原菌的监测工作对临床治疗有着重要意义。

Distribution and susceptibility of pathogens isolated from postoperative infections in liver transplantation recipients

Objective To investigate the epidemiology of bacterial infections after liver transplantation and analyze the antimicrobial susceptibility of major pathogens to provide reference for clinical therapy. Methods A retrospective survey was conflucted in 174 patients who underwent liver transplantation during 2001 and 2004. Identification and susceptibility of pathogens were assayed by Microscan Walkaway 40 Automatic System. Results Infection was identified in 59.8% of the 174 patients after liver transplantation. A total of 218 non-duplicate strains were isolated. Most infections were caused by single pathogen. The infection was frequently identified in respiratory tract, biliary tract, blood stream or intra-abdominal cavity. The top 5 pathogens were Acinetobacter baumannii, Staphylococcus aureus, Pseudornonas aeruginosa, Stenotrophomonas maltophilia and Escherichia coli. Gram-negative bacilli were usually resistant to multiple antimicrobial agents, but less resistant to piperacillintazobactam or imipenem. Most of S. aureus isolates were methicillinresistant, which were susceptible to vancomycin. Conclusions Pathogens of postoperative infections in liver transplantation recipients are mostly multi-drug resistant. The microbiological surveillance is important for guiding clinical therapy.