摘要
目的探讨肝移植术后肺部细菌感染的流行病学特征。方法采用回顾性调查方法,分析53例肝移植受者肺部感染的发生率、死亡率和相对危险度,肺部感染发生的时间、相关因素、临床表现、致病菌种类和分布、细菌耐药性。结果53例肝移植受者,33例发生肺部感染,感染率62.3%,死亡6例,死亡率18.2%,肺部感染死亡相对危险度是非肺部感染的1倍。感染均发生于术后1个月内,最常见于术后第1周。移植前后有多种因素与术后肺部感染有关或提示肺部感染。痰液、咽拭子和气道吸引液中致病菌最多,肺炎克雷伯菌、大肠埃希菌最为常见。G-菌大部分对氨基糖苷类、内酰胺酶抑制剂复合制剂和碳青霉烯类敏感,G+菌仅对糖肽类敏感,均对喹诺酮类、三、四代头孢菌素耐药。结论肝移植术后肺部感染率、死亡率高,时间早,临床表现不典型,感染与多种因素有关,致病菌种类多,分布广,对常用抗生素耐药。
Objective To explore the clinical epidemiological characteristics of the lung infection after orthotopical liver transplantation. Methods The clinical data included infection morbidity, mortality, infectious times and relative factors, clinical manifestations, the bacterial strains and distributions of the pathogens,the bacterial resistances of the 53 liver transplantation recipients from 2003. 3 to 2006. 12 were summarized and analyzed retrospectively. Results Among 53 recipients,33 developed lung infectious and 6 died. The mobidity was 62. 3% and mortality was 18. 2%, with a OR of 1. 0. Lung infection predominantly occurred in the first month, especially in the first week after transplantation. There were many factors related to lung infections. Various pathogens, especially Kdebsialla, Escherichia Coli and Staphylococus Hominis were isolated from sputum, airway suction drainages and throat swabs. Most of the G^- bacteria were sensitive to aminoglycosides, 13 lactam and lactamase compounds and carbapenems while G^- bacteria were sensitive only to glycopeptides. All the bacteria were resistant to quinolones, β lactams of third and forth generation. Conclusions After liver transplantation, the morbidity and mortality of the lung infections are high. The infections develope at earlier stage, manifest nontypical clinical features. Many factors are revealed to be relevant to the lung infections, meanwhile various drug-resistant pathogen strains are isolated.
出处
《中国呼吸与危重监护杂志》
CAS
2008年第1期35-39,共5页
Chinese Journal of Respiratory and Critical Care Medicine
关键词
肝移植
肺部感染
相关因素
致病菌
耐药性
Liver transplantation
Lung infection
Relative factor
Pathogen
Drug resistance
