摘要
目的:了解肝癌患者肝移植术后感染病原菌的分布和耐药性,为临床经验性抗感染治疗提供参考。方法:回顾性分析2010～2016年222例肝癌肝移植患者临床资料和实验室结果,根据感染情况将病例分为感染组和非感染组,对病原菌分布及耐药性进行分析,并对感染组可能的危险因素进行比较。结果:222例患者中60例出现感染,感染率27. 03%。感染部位常见于呼吸道、腹腔及血液等,分别占感染的50. 4%、17. 6%、16. 8%。共分离出病原菌126株,以革兰阴性杆菌为主,占比75. 4%,革兰阳性球菌与真菌分别占20. 6%和4. 0%。其中,呼吸道感染主要病原菌为鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌,分别占比39. 7%、15. 9%、14. 3%;腹腔感染常见病原菌是屎肠球菌(31. 8%)和鲍曼不动杆菌(18. 2%);而屎肠球菌(23. 8%)、肺炎克雷伯菌(19. 0%)及头状葡萄球菌(9. 5%)位列血流感染病原菌前3位。鲍曼不动杆菌对临床常见抗生素的耐药性普遍高于50%,仅对多粘菌素(100%)、替加环素(85. 7%)、米诺环素(68. 7%)较为敏感;肠杆菌科细菌对亚胺培南、美罗培南、哌拉西林/他唑巴坦较为敏感,耐药率均低于10%,但对三代头孢、喹诺酮类耐药率较高;未分离出对万古霉素、利奈唑胺、替加环素耐药的屎肠球菌。经单因素分析显示,患者住院天数、终末期肝病模型(model for end-stage liver disease,MELD)评分及术前凝血酶原时间(prothrombin time,PT)水平是肝移植术后感染的危险因素(P <0. 05)。多因素Logistic回归分析显示,患者住院时间为肝移植术后感染的独立危险因素。结论:肝癌患者肝移植术后感染率较高,感染部位主要是呼吸道、腹腔和血液,病原菌以革兰阴性杆菌为主,但在不同感染部位分布有所差异。临床应针对感染风险因素采取有效的预防控制措施,根据病原菌种类及耐药性合理选用抗生素。
Objective:To investigate the distribution and drug resistance of bacterial infections after liver transplantation in patients with hepatocellular carcinoma,and to provide reference for clinical therapy.Methods:We retrospectively analyzed the medical records and microbiological documenta-tion of 222patients with hepatocellular carcinoma who received liver transplantation in our hospitaI from 2010to 2016.Those patients were divided into two groups :the infected group and the uninfected group.The distribution of pathogens and drug re- sistance were assessed,and possible nak factors were compared between the two groups.Results :Of 222patients undergone liver transplantation,60cases experienced infections,and the morbidity rate was 27.03%.The infection was frequently i- dentified in respiratory tract (50.4%),intro-abdominal cavity (17.6%)and blood stream (16.8%).A total of 126 strains of pathogens were isolated.Gram-negative bacteria (75.4%)were the main pathogenic bacteria..Gram-positive bac- teria and fungus accounted for 20.6%and 4%respectively.The main pathogens leading to respiratory tract infection were Aeinetobacter banmannii,Klebslella pneumoniae and Pseudomonas aeruginosa,accounting for 39.7%,15.9%and 14.3% respectively.Enterococcus faecium (31.8%)and Acinctobactar baumannii (18.2%)were the common pathogens leading to infections in intro-abdominal cavities.Meanwhile Enterococcus faecium (23.8%),Klebsiella pneumoniae (19.0%)and Staphylococcus capitis (9.5%)were the top three pathogenic bacteria leading to bloodstream infection.Acinetobacter bau- mannii was resistant to common antibiotms,and the drug resistance rate was more than 50%.But polymyxin (100%),tige- cyeline (85.7%),and minocyeline (68.7%)had high antibacterial activity against it.Enterobacteriaceae streams were still susceptible to imipenem,merupenem and piperacillin/tazobactam,and the resistance rate was lower than 10%,But they were highly resistant to cephalosporin and quinolones antibiotics.No Enterococcal strain was resistant to vancomycin,hnexol- id and tigeeycline.Univariate analysis showed that length of hospital stay,model for end-stage liver disease score and pro- thrombin time were associated with infection (P <0.05).Logistic regression analysis suggested that length of hospital stay was an independent risk factor of infection after liver transplantation.Conclusion:Nosoeomial infections to hepatocellular carcinoma patients after liver transplantation are relatively high.They mostly occur in respiratory tract,intro-abdominaI cavity and blood stream.Pathogenic bacteria are mainly gram-negative bacteria,which has different distribution in varied sites of infection.Clinicians should take account of the risk factors and rationally choose antibiotics based on stroan type and characteristics of resistance.
作者
胥萍瑶
张为利
赖巍
张忠伟
吴思颖
刘雅
康梅
Xu Pingyao;Zhang Weili;Lai Wei;Zhang Zhongwei;Wu Siying;Liu Ya;Kang Mei(Division of Clinical Microbiology,Department of Laboratory Medicine,West China Hospital,Sichuan University,Chengdu 610041,China;Laboratory Department,Sichnan Cancer Hospital &Institute,Sichuan Cancer Center,Cancer Hospital affiliate to School of Medicine,UESTC ,Chengdu610041,China;Intensive Care Unit,West China Hospital,Sichuan University,Chengdu 610041,China)
出处
《肿瘤预防与治疗》
2018年第6期395-401,共7页
Journal of Cancer Control And Treatment
关键词
肝癌
肝移植
感染
病原菌
危险因素
Hepatocellular carcinoma
Liver transplantation
Infection
Pathogens
Risk factors
