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

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

    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。

     

    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.

     

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