肾移植术后感染的临床和病原学研究

发布时间：2019-03-24 11:22

【摘要】：背景肾移植已经成为治疗终末期肾病的一个最有效和成熟的方法。因为术后病人长期处于免疫抑制状态,免疫功能不健全,因此容易产生多种并发症,包括出血、感染、排斥反应、高血压等等。其中感染是常见的并发症和死亡原因,据西方国家统计,肾移植术后第一年内大约有超过百分之七十的术后患者发生过感染,并且感染后的病死率较高。尤其是呼吸系统的感染,感染进展迅速,预后较差,死亡率高。肾移植术后1年内患者并发肺部感的发病率,国内报道约8.70%~14.96%,国外报道约为5%~10%。在众多感染中,肺部的感染较为严重,是术后患者死亡的主要原因之一,对术后患者的生存率影响很大。目的回顾性分析我院感染患者的临床特征,病原体分布,耐药情况,等资料,为以后临床上治疗肾移植术后感染提供理论依据。方法回顾性分析郑州大学第一附属医院肾移植科2014年12月至2016年12月诊治的119名术后感染患者的临床资料。包括:年龄,性别,感染发生时间、感染部位、感染症状,免疫抑制方案、免疫抑制剂药物浓度、病原学检查资料以及疾病的转归。重点研究肾移植术后肺炎及细菌真菌耐药性情况。结果1.119名肾移植术后感染患者共发生158次感染,24人至少发生2次感染(20.1%)。2.79例肾移植术后肺炎最常发生于术后2~6月。38例病原学诊断明确(48.1%),细菌感染最为常见(34.2%),其后依次为混合感染(23.6%)、巨细胞病毒感染(21%)。3细菌中以大肠埃希菌和鲍曼不动杆菌较为常见。4.79例肺炎患者,死亡2例,死亡率2.5%结论呼吸道及泌尿道为肾移植术后感染的常见部位,肾移植术后感染最常发生于术后2~6月,不同时期肺炎具有不同的临床特点,分离病原体以细菌为主,细菌对常用抗生素耐药情况严重。
[Abstract]:Background Renal transplantation has become one of the most effective and mature methods for the treatment of end-stage kidney disease. Because the patient is in immunosuppressive state for a long time and the immune function is not perfect, it is easy to produce many complications, including bleeding, infection, rejection, hypertension and so on. Infection is one of the most common complications and causes of death. According to the statistics of western countries, more than 70% patients have been infected in the first year after renal transplantation, and the mortality after infection is relatively high. Especially respiratory infection, the progress of infection is rapid, prognosis is poor, mortality is high. Within one year after renal transplantation, the incidence rate of pulmonary sensation was about 8.70% in China and 5% in foreign countries, which was about 8.70% and 14.96% in China and 5% and 10% in foreign countries, respectively. Among many infections, lung infection is one of the main causes of postoperative death, and has a great influence on survival rate of postoperative patients. Aim to analyze retrospectively the clinical characteristics, pathogen distribution, drug resistance and other data of patients with renal transplantation in our hospital, so as to provide a theoretical basis for future clinical treatment of infection after renal transplantation. Methods the clinical data of 119 patients with postoperative infection in the Department of Renal Transplantation, first affiliated Hospital of Zhengzhou University from December 2014 to December 2016 were retrospectively analyzed. Including: age, sex, infection time, infection site, infection symptoms, immunosuppressive regimen, immunosuppressive drug concentration, etiological examination data and prognosis of the disease. The emphasis was placed on the study of pneumonia and bacterial fungal resistance after renal transplantation. Results there were 1.119 cases of infection after renal transplantation, 24 cases had at least two infections (20.1%), 2.79 cases of pneumonia most frequently occurred in 2 ~ 6 months after renal transplantation, 38 cases (48.1%) were diagnosed pathologically. Bacterial infection was the most common (34.2%), followed by mixed infection (23.6%) and cytomegalovirus infection (21%). 3Escherichia coli and Acinetobacter baumannii were the most common bacteria. 4.79 patients with pneumonia were infected by E. coli and Acinetobacter baumannii. The mortality rate was 2.5%. Conclusion Respiratory tract and urinary tract infection are common sites after renal transplantation. Infection after renal transplantation occurs most frequently from 2 to 6 months after renal transplantation. Pneumonia has different clinical characteristics in different periods. The isolated pathogens were mainly bacteria, and the resistance of bacteria to commonly used antibiotics was serious.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R699.2

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