成人尸体肝移植受者感染病原菌分布及耐药性分析

目的 探讨肝移植术后感染病原菌的分布及耐药特点，为临床合理用药提供参考。方法 对2015年4月—2018年3月某三甲医院检出病原菌的肝移植受者感染病原菌分布、标本来源及耐药性进行回顾性分析。结果 共计病原菌255株，主要来源于呼吸道标本(57.25%)和血液(14.90%)。病原菌分布以革兰阴性菌为主，占69.80%(178/255)，其中以鲍曼不动杆菌(23.53%)、肺炎克雷伯菌(23.14%)及铜绿假单胞菌(8.63%)为主；耐碳青霉烯类鲍曼不动杆菌(CRAB)和耐碳青霉烯类肺炎克雷伯菌(CRKP)比例较高，分别为93.3%和57.6%，但对替加环素、多黏菌素较为敏感，耐药率均低于11%。革兰阳性菌占14.12%(36/255)，以屎肠球菌居多，所有革兰阳性菌均未发现对万古霉素、利奈唑胺、替加环素耐药的菌株。真菌占16.08%(41/255)，以呼吸道标本培养的念珠菌为主。结论 肝移植术后受者分离的的病原菌以革兰阴性菌为主，且多为多重耐药菌，结合药敏结果合理选择抗菌药物治疗术后感染对受者生存率提高非常重要。

Analysis on distribution and drug resistance of pathogens infected in adult deceased donor liver transplant recipients

Abstract Objective To investigate the distribution and drug resistance of pathogens infected in liver transplant patients, so as to provide references for clinical reasonable use of antibiotics. Methods The distribution and drug resistance of 87 deceased donor liver transplant recipients in a class 3A hospital from April 2015 to March 2018 were retrospectively analyzed. Results Totally 255 strains of pathogens were isolated, and the pathogens were isolated mainly from respiratory specimens (57.25%) and blood samples(14.90%). Gram-negative bacteria were the main pathogenic bacteria and accounted for 69.80% (178/255), which mainly consisted of Acinetobacter baumannii (23.53%), Klebsiella pneumoniae (23.14%) and Pseudomonas aeruginosa (8.63%). Carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Klebsiella pneumoniae (CRKP) had a high proportion, and the resistance rates were 93.3% and 57.6% respectively. Both of them had low drug resistance to tigecycline and polymyxin. The resistance rates were lower than 11%. Gram-positive bacteria accounted for 14.12% (36/255), mainly Enterococcus faecium. Addtionally, no Gram-positive bacteria resistant to vancomycin, linezolid, and tigecycline has been found. Fungi were accounted for 16.08% (41/255), which were mainly Candida isolated from respiratory specimens. Conclusion The rate of infections after liver transplantation was high. The pathogens were mainly Gram-negative bacteria which showed multi-drug resistance. Therefore, the reasonable use of antibiotics based on drug sensitivity results is very important to improve the liver transplant recipients' survival rate.