肝移植术后大肠埃希菌血行感染耐药及危险因素分析

目的 探讨肝移植术后血行感染中大肠埃希菌的耐药、临床结果及危险因素.方法 回顾分析1993年1月至2010年5月,中山大学附属第一医院移植科肝移植术后血行感染中大肠埃希菌患者资料,对患者的资料(如:抗生素耐药、术式及危险因素)进行分类统计.结果 695例肝移植患者中,83例(7.6％)88次出现革兰阴性球菌血行感染,以大肠埃希菌(23例)最为常见.大肠埃希菌对碳青酶烯类抗生素均为100％敏感,对哌拉西林/他唑巴坦耐药率在5％以下,而对环丙沙星、庆大霉素、氨苄西林/克拉维酸耐药率基本都在60％以上.针对肝移植术后大肠埃希菌血行感染的危险因素分析发现,施行胆肠吻合术(P＜0.001)和胆道并发症(P＜0.001)是出现大肠埃希菌血行感染的危险因素.感染后15 d病死率大肠埃希菌血行感染高于非大肠埃希菌血行感染(P=0.01),血行感染后30 d、1年病死率差异无统计学意义.结论 肝移植术后大肠埃希菌血行感染,对多种抗生素耐药,但对碳青酶烯类、哌拉西林/他唑巴坦敏感.施行胆肠吻合术、胆道并发症是出现肝移植术后大肠埃希菌血行感染的危险因素.肝移植术后大肠埃希菌血行感染后的15 d病死率显著增加.

A 17-year study of bloodstream Escherichia coli infection after liver transplantation: resistance rate, risk factor and mortality

Objective To explore the resistance rate,risk factors and mortality of Escherichia coli bloodstream infections (BSI) after liver transplantation.Methods From January 1993 to May 2010,a retrospective analysis of Escherichia coli in liver transplants were conducted.Results A total of 88 BSI occurred in 83/695 patients and Escherichia coli ( n =23 ) was most commonly found.Carbapenem and piperacillin-tazobactam were the most consistently active against Escherichia coli while the resistance rate to enterococcus for ciprofloxacin,gentamycin,ampicillin-clavulanic acid was over 60％.Univariate analysis identified the following variables as risk factors for Escherichia coli bacteremia:cholangioenterostomy ( P ＜0.001 ) and ductal complications ( P ＜ 0.001 ).Escherichia coli bloodstream infection could increase the mortality at 15 days after bloodstream infection.No significant difference in mortality occurred at 30 days and 1 year after enterococcal bacteremia.Conclusion Escherichia coli after liver transplantation is resistant to agents but commonly active to carbapenem and piperacillin-tazobactam.The risk factor associated with Escherichia coli bloodstream infections are cholangioenterostomy and ductal complications.Escherichia coli bloodstream infection can increase the mortality at 15 days after bloodstream infection.