肝移植患者术后感染病原菌流行特点

发布时间：2018-01-12 19:10

本文关键词：肝移植患者术后感染病原菌流行特点　出处：《中国病原生物学杂志》2016年05期 　论文类型：期刊论文

【摘要】：目的探讨患者术后不同时期感染病原菌的特点及耐药情况。方法以2012-2015年云南地区实施同种异体肝移植感染患者为研究对象,收集痰液,咽拭子,血液,腹腔引流液,胆汁,导管,尿液及粪便等并进行常规病原学培养。采用VTIEK-32全自动微生物鉴定仪对菌种进行鉴定,并对院内感染30d前后的病原菌分布进行比较。采用K-B纸片法进行药敏试验,判定标准参照美国临床实验室标准化研究所标准(2015版)。结果 112例患者分离出221株病原菌,其中革兰阴性菌106株(占47.96%),革兰阳性菌92株(占41.63%),真菌23株(占10.41%)。在革兰阴性菌中以铜绿假单胞菌(32株),不动杆菌属(26株),大肠埃希菌(22株)和肺炎克雷伯菌(15株)为主;在革兰阳性菌中以肠球菌(29株),金黄色葡萄球菌(24株)和链球菌(22株)为主;真菌以白色假丝酵母菌(8株),光滑假丝酵母菌(6株)和曲霉菌(5株)为主。30d以内分离出病原菌117株,以革兰阴性菌(68株)为主;30d以上分离出病原菌91株,以革兰阳性菌(53株)为主。呼吸道分离68株病原菌,其中革兰阴性菌36株(占52.94%),革兰阳性菌23株(占33.82%),真菌9株(占13.24%)。铜绿假单胞菌对临床常用抗生素的耐药率分别为氨苄西林87.5%、哌拉西林81.25%、头孢唑林100%、头孢克洛65.63%、头孢噻肟68.75%、头孢他啶56.25%、头孢吡肟46.88%、环丙沙星62.50%、氨曲南71.88%、妥布霉素65.63%、阿米卡星50.00%、美罗培南25.00%和亚胺培南9.38%。讨论肝移植后院内感染严重影响着患者预后和病死率。肝移植患者感染治疗时应进行药敏试验,以避免和减少多重耐药菌出现。
[Abstract]:Objective to investigate the characteristics and drug resistance of infected pathogens in different period after operation. Methods the sputum was collected from patients with allogeneic liver transplantation infection in Yunnan from 2012 to 2015. Pharynx swabs, blood, abdominal drainage fluid, bile, catheter, urine and feces were cultured for routine etiology. The bacteria were identified by VTIEK-32 automatic microbiological identification instrument. The distribution of pathogens before and after 30 days of nosocomial infection was compared. Results 221 strains of pathogenic bacteria were isolated from 112 patients, including 106 strains of Gram-negative bacteria (47.96%). 92 strains of Gram-positive bacteria (41.63%), 23 strains of fungi (10.41%), 32 strains of Pseudomonas aeruginosa and 26 strains of Acinetobacter in Gram-negative bacteria. 22 strains of Escherichia coli and 15 strains of Klebsiella pneumoniae; Among Gram-positive bacteria, 29 strains of Enterococcus, 24 strains of Staphylococcus aureus and 22 strains of Streptococcus spp. The main fungi were Candida albicans (8 strains), Candida smooth (6 strains) and Aspergillus (5 strains). Within 30 days, 117 strains of pathogenic bacteria and 68 strains of Gram-negative bacteria were isolated. More than 30 days, 91 strains of pathogenic bacteria were isolated, 53 strains of Gram-positive bacteria were isolated, and 68 strains of pathogenic bacteria were isolated from respiratory tract, of which 36 strains (52.94%) were Gram-negative bacteria. There were 23 Gram-positive bacteria (33.82%) and 9 fungi (13.24%). The resistance rate of Pseudomonas aeruginosa to commonly used antibiotics was 87.5%. Piperacillin 81.25, cefazolin 100, cefaclor 65.63, cefotaxime 68.75, ceftazidime 56.2525, cefepime 46.88%. Ciprofloxacin 62.50, aztreonam 71.88, tobramycin 65.63 and amikacin 50.00%. Meropenem 25.00% and imipenem 9.38. Discuss that nosocomial infection after liver transplantation seriously affects the prognosis and mortality of patients. To avoid and reduce the emergence of multidrug resistant bacteria.
【作者单位】：云南大理大学护理学院;
【分类号】：R657.3;R446.5
【正文快照】： 肝移植是目前治疗多种急慢性肝脏疾病终末期的有效手段,但是由于患者长期服用抑制类药物及自身基础疾病和手术创伤等因素导致患者免疫力下降,患者术后感染严重影响着患者预后和病死率[1-2]。术后感染常见于初期的2个月,并有60%的并发症与它相关,病情严重的可能导致死亡[3-4]。

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