公民逝世后器官捐献肾移植早期多重耐药菌感染的临床研究

李智斌; 张更; 刘克普; 阮东丽; 高龙; 王会龙; 郑文峰; 马帅军; 秦卫军; 袁建林

doi:10.3969/j.issn.1674-7445.2017.05.010

公民逝世后器官捐献肾移植早期多重耐药菌感染的临床研究

doi: 10.3969/j.issn.1674-7445.2017.05.010

710032 西安, 第四军医大学西京医院泌尿外科

详细信息

通讯作者:
袁建林, Email:jianliny@fmmu.edu.cn

中图分类号: R617;R619⁺.3;R631
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出版历程
- 收稿日期: 2017-06-30
- 网络出版日期: 2021-01-19
- 刊出日期: 2017-09-15

Clinical study of early infection of multi-drug resistant organisms after renal transplantation from organ donation after citizen's death

Department of Urology Surgery, Xijing Hospital of the Forth Military Medical University, Xi'an 710032, China

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Corresponding author: Yuan Jianlin, Email: jianliny@fmmu.edu.cn

摘要

摘要: 目的探讨公民逝世后器官捐献肾移植术后早期多重耐药菌（MDROs）感染的临床特点和防治。方法回顾性分析2011年11月至2016年9月西京医院实施同种异体肾移植术并规律随访的166例患者的临床资料。比较心脏死亡器官捐献（DCD）肾移植受者和亲属活体肾移植受者的一般情况。观察MDROs感染的发生率、发生时间、病程、并发症、感染部位、病原学种类，总结患者的治疗方法与预后情况。结果 DCD肾移植受者和亲属活体肾移植受者术后早期的MDROs感染发生率分别为14%和2%，移植物功能延迟恢复发生率分别为13%和2%，差异均有统计学意义（均为P < 0.05）；移植肾丢失发生率分别为8%和2%，病死率分别为5%和1%，差异均无统计学意义（均为P < 0.05）。11例DCD肾移植术后发生MDROs感染，最常见的感染部位为泌尿系统（6例），最常见的病原菌为大肠埃希菌（4例）。所有感染患者均根据细菌培养及药敏结果选择适当抗生素，足量、足疗程治疗。预后良好8例，移植肾切除1例，死亡2例。结论 DCD肾移植早期多重耐药菌感染的发生率较亲属活体供肾移植高。严格筛选供体，早期发现、密切监测、及时治疗，可以有效减少MDROs的发生及改善预后。
- 肾移植 /
- 公民逝世后器官捐献 /
- 心脏死亡器官捐献 /
- 多重耐药菌 /
- 感染 /
- 大肠埃希菌 /
- 泌尿系统 /
- 移植肾感染 /
- 肺部感染 /
- 菌血症
Abstract: Objective To investigate the clinical characteristics, prevention and treatment of multi-drug resistant organisms (MDROs) infection early after renal transplantation from donation after citizen's death. Methods Clinical data of 166 patients undergoing allogeneic renal transplantation and regular follow-up in Xijing Hospital from November 2011 to September 2016 were retrospectively analyzed. General conditions were statistically compared between the recipients undergoing renal transplantation from donation after cardiac death (DCD) and their counterparts receiving living related donor renal transplantation. The incidence of MDROs infection, onset time, course of diseases, complications, infection site and etiological type were observed. The therapeutic methods and clinical prognosis were summarized. Results The incidence of MDROs infection early after renal transplantation in the recipients undergoing DCD renal transplantation was 14%, significantly higher than 2% in those receiving living related donor renal transplantation, and 13% and 2% for the incidence of delayed graft function with statistical significance (both P < 0.05). The incidence of renal graft loss was 8% and 2%, and 5% and 1% for the mortality rate without statistical significance between two groups (both P < 0.05). MDROs infection occurred in 11 patients after DCD renal transplantation. The most common infection site was urinary system (n=6) and the most prevalent pathogenic bacterium was Escherichia coli (n=4). All patients infected with MDROs were treated with a sufficient dosage of effective antibiotics according to the outcomes of bacterial culture and drug sensitivity test. Eight patients obtained favorable clinical prognosis, one underwent nephrectomy and two died. Conclusions The incidence of MDROs infection early after DCD renal transplantation is higher than that after living related-donor renal transplantation. Strict donor screening, early detection, intimate monitoring and timely treatment can effectively reduce the risk of MDROs and enhance clinical prognosis.
- Renal transplantation /
- Donation after citizen's death /
- Donation after cardiac death /
- Multi-drug resistant bacteria /
- Infection /
- Escherichia coli /
- Urinary system /
- Kidney graft infection /
- Pulmonary infection /
- Bacteremia

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表 1 DCD肾移植受者与亲属活体肾移植受者术后情况的比较

Table 1. Comparison of postoperative situation between DCD renal transplant recipients and living related renal transplant recipients[n (%)]

移植类型	n	MDROs感染	DGF	移植肾丢失	死亡
DCD	77	11(14)	10(13)	6(8)	4(5)
亲属活体	89	2(2)	2(2)	2(2)	1(1)
χ²值		8.290	7.100	1.690	1.160
P值		0.004	0.008	0.190	0.280

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表 2 DCD肾移植受者术后多重耐药菌感染的情况及预后

Table 2. The conditions and prognosis of recipients with MDROs infections after renal transplantation from DCD

例序	性别	年龄(岁)	感染发生时间(d)	感染部位	首发症状	病原菌	培养标本种类	目标性治疗的抗生素	治疗时间(周)	手术并发症	预后
1	男	46	12	移植肾周感染	发热	溶血葡萄球菌	引流液	利奈唑胺	1	无	良好
2	男	28	11	肺部感染	发热、咳痰、咯血	鲍曼不动杆菌、大肠埃希菌	痰液	头孢哌酮钠、替加环素	5	无	死亡
3	男	27	14	移植肾伤口感染	伤口裂开	MRSA	引流液	利奈唑胺	2	无	良好
4	男	29	21	泌尿系统感染	发热、尿液浑浊	鲁菲不动杆菌、铜绿假单胞菌	尿液	头孢哌酮钠	10	DGF	良好
5	男	46	60	肺部感染	发热、咳嗽、咳痰	产酸克雷伯菌、大肠埃希菌	痰液	美罗培南	4	无	良好
6	男	48	10	泌尿系统感染	发热	屎肠球菌	尿液	替加环素	2	无	良好
7	男	56	60	泌尿系统感染	发热、尿液浑浊	铜绿假单胞菌	尿液	头孢哌酮钠	3	长期留置膀胱造瘘管	良好
8	男	46	5	菌血症、移植肾周感染、泌尿系统感染	发热	大肠埃希菌	血液、引流液、尿液	亚胺培南-西司他汀钠	4	无	良好
9	男	31	40	移植肾周、泌尿系统、肺部感染	发热、尿急、尿痛	MRSA、鲍曼不动杆菌、肺炎克雷伯菌	引流液	美罗培南、利奈唑胺	4	DGF	死亡
10	女	46	7	菌血症、移植肾周感染	发热	大肠埃希菌	血液、引流液	亚胺培南-西司他汀钠	6	无	移植肾切除
11	女	16	60	泌尿系统感染	无症状菌尿	粪肠球菌	尿液	利奈唑胺	2	无	良好

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表 3 供者细菌感染处理的核心原则^[10]

Table 3. The core principles of management for donor bacteria infections

细菌感染情况	处理原则
排除隐匿性菌血症	血培养
供者处于革兰阴性杆菌、金黄色葡萄球菌等病原体活动性感染期	受者需接受至少两周的抗感染治疗，若病原体致病力低危，可缩短疗程
供者存在致病性菌血症	受者术后抗生素治疗需维持两周左右
供者存在局部感染，未累及移植器官	不需要对受者进行抗感染治疗，但脑膜炎除外，由于其经常引起隐匿性菌血症；肺炎链球菌引起的脑膜炎，在对供、受者进行适当的抗生素治疗后，移植手术仍可进行

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