原位肝移植术后早期细菌、真菌感染的临床研究

目的:探讨原位肝移植术后病人细菌、真菌感染的临床特点,常见病原菌及其耐药性,总结防治经验。方法:就74例原位肝移植病人术后,针对感染进行各个系统的定期检测,观察感染发生时间、部位、病原谱及药物敏感性等指标。结果:74例肝移植病人中,术后并发感染者48例,感染率为64.9%;包括单纯细菌感染24例(32.4%),单纯真菌感染6例(8.1%),混合感染(细菌合并真菌)18例(24.3%)。其中革兰阴性杆菌共占34.6%,革兰阳性球菌占34.1%。真菌占31.3%。感染大部分发生在术后1个月以内。最常见的感染部位是呼吸道,其次为尿道和胆道。感染的病原菌依次为金黄色葡萄球菌、铜绿假单胞菌和肺炎克雷伯菌。病原菌中革兰阴性杆菌对头孢吡肟和美罗培南敏感性较高,革兰阳性球菌对万古霉素和替考拉宁敏感性较高。结论:肝移植病人术后感染是影响存活的重要因素,应重视移植术前后对病人的监测和预防性抗生素应用等措施。在处理感染病情时,应综合考虑病原菌谱、药敏结果、多部位复合感染及混合感染等因素。

Infection occurring during the early postoperative period in orthotopic liver transplantation recipients

Objective To explore the incidence of occurrence of microbial pathogens and their drug resistance in orthotopic liver transplantation (OLT) recipients. Methods A retrospective study of 76 cases was carried out; the incidence and drug resistance of pathogens isolated from various specimen were analyzed. Results Infections developed in 48 (64.9%) cases. Among the 48 cases, 42 (56.8%) were infected with bacterial, 24 (50.0%) with fungal and 18 (24.3%)with combined bacterial and fungal. The pathogens appeared in OLT patients were mainly G-negative bacilli (34.6%),G-positive cocci (34.1%) and fungus (31.3%). Respiratory tract, urethra and bile duct were the most common infectious sites. The 3 most common strains detected were Staphylococcus aureus, Pseudomonas aeruginosa and Klebsiella pneumoniae. Conclusions Infection is the major cause of death among the OLT recipients. To use antibiotics appropriately, it is very important to specify the pathgen(s) and their spectrum of drug resistance.