肝移植术后肠球菌血行感染的耐药及危险因素分析

目的 了解肝移植术后血行感染中肠球菌的耐药、临床结果及危险因素,对肝移植术后血行感染的治疗提供参考依据.方法 1993年1月至2010年5月,回顾分析中山大学附属第一医院肝移植术后血行感染中肠球菌患者资料.结果 695例肝移植患者中,53例(7.6%)出现革兰阳性球菌血行感染,共有革兰阳性菌58株,以肠球菌(30株)最为常见.肠球菌对糖肽类、利奈唑胺均为敏感,对克林霉素、红霉素、阿莫西林/克拉维酸、亚胺培南、利福平、庆大霉素、环丙沙星耐药率都在70%以上.针对肝移植术后肠球菌血行感染的危险因素分析发现,再次移植(P=0.03)、胆道并发症(P=0.02)是出现肠球菌血行感染的危险因素.肠球菌血行感染和非肠球菌血行感染后15 d病死率差异有统计学意义(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 肝移植术后肠球菌血行感染后的15 d死亡率显著增加,对多种抗生素耐药,但对糖肽类、利奈唑胺敏感.再次移植、胆道并发症是出现肝移植术后肠球菌血行感染的危险因素.

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

Objective To explore the resistance rate, risk factor and mortality of enteroccal bloodstream infections (BSI) after liver transplantation. Methods From January 1993 to May 2010, a retrospective analysis of enteroccus in liver transplants were conducted. Results Fifty-eight BSI occurred in 53 of 695 patients. And a total of 30 enterocci were isolated. Linezolid and glycopeptide antibiotics were the most consistently active against the Enterococcus. The resistance rates to Enterococcus for erythromycin,clindamycin, imipenem, ciprofloxacin, gentamycin and ampicillin-clavulanic acid were all over 70%. The univariate analysis identified the following variables as the risk factors for enterococcal bacteremia:retransplantion ( P = 0. 03 ) and biliary duct complications ( P = 0. 02 ). Enterococcal bloodstream infection increased the mortality at Day 15. No significant difference was found in the mortality rate at Day 30 and 1 year after enterococcal bacteremia. Conclusion Enterococcus after liver transplantion is resistant to multiple agents but active to linezolid and glycopeptide antibiotics. The risk factors commonly associated with enteroccal BSI are retransplantion and biliary duct complications. Enterococcal BSI can increase the mortality at Day 15 after liver transplantation.