Distribution and drug resistance characteristics of pathogens in recipients undergoing simultaneous pancreas-kidney transplantation
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摘要:
目的 探讨胰肾联合移植供、受者病原菌分布特点及耐药特征。 方法 回顾性分析231例胰肾联合移植供、受者的临床资料。供、受者标本采用VITEK-2分析仪进行病原菌鉴定，K-B法进行药敏试验。分析供受者标本病原菌来源分布与构成比、多重耐药菌分布特征、受者感染发生情况及病原菌耐药特征。 结果 供者1 294份标本共培养出395株病原菌，检出率为30.53%。革兰阴性菌以肺炎克雷伯菌为主，革兰阳性菌以金黄色葡萄球菌为主，真菌主要为白假丝酵母菌。受者10 507份标本共培养出2 690株病原菌，检出率为25.60%。革兰阴性菌以嗜麦芽假单胞菌为主，革兰阳性菌以屎肠球菌为主，真菌主要为白假丝酵母菌。供者395株病原菌中，耐甲氧西林金黄色葡萄球菌（MRSA）15株、产超广谱β内酰胺酶（ESBL）阳性耐药菌16株、耐碳青霉烯类铜绿假单胞菌（CR-PA）8株、耐碳青霉烯类鲍曼不动杆菌（CR-AB）21株、耐碳青霉烯类肠杆菌科细菌（CRE）2株、多重耐药/泛耐药铜绿假单胞菌（MDR/PDR-PA）1株；受者2 690株病原菌中，ESBL阳性耐药菌73株、CR-PA 44株、CR-AB 31株、MDR/PDR-PA 3株。受者发生供者来源性感染1例，术后1年内发生肺炎69例、泌尿系统感染52例、腹腔感染35例、血行感染2例。革兰阴性菌对部分抗生素耐药；革兰阳性菌对万古霉素敏感；真菌对两性霉素B敏感。 结论 革兰阴性菌是SPK受者主要感染病原菌，对部分抗生素耐药，未获得培养结果前可经验性应用抗生素，后根据结果合理选用敏感抗生素以提高SPK受者生存率。 Abstract:Objective To investigate the distribution and drug resistance characteristics of pathogens in donors and recipients undergoing simultaneous pancreas-kidney transplantation (SPK). Methods Clinical data of 231 pairs of donors and recipients undergoing SPK were analyzed retrospectively. The pathogens of samples from donors and recipients were identified by VITEK-2 analyzer, and drug sensitivity test was performed by K-B method. The source distribution and composition ratio of pathogens in donor and recipient samples, distribution characteristics of multi-drug resistant organism, infection of recipients and drug resistance characteristics of pathogens were analyzed. Results A total of 395 strains of pathogens were cultured from 1 294 donor samples, and the detection rate was 30.53%. Gram-negative bacteria mainly consisted of klebsiella pneumoniae, Gram-positive bacteria mainly comprised staphylococcus aureus, and fungi primarily included candida albicans, respectively. In total, 2 690 strains of pathogens were cultured from 10 507 recipient samples, and the detection rate was 25.60%. Gram-negative bacteria mainly consisted of pseudomonas maltophilia, Gram-positive bacteria primarily comprised enterococcus faecalis, and fungi mainly included candida albicans, respectively. Among 395 pathogens of donors, 15 strains of methicillin-resistant staphylococcus aureus (MRSA), 16 strains of extended-spectrum β-lactamase (ESBL) positive drug-resistant bacteria, 8 strains of carbapenem-resistant pseudomonas aeruginosa (CR-PA), 21 strains of carbapenem-resistant acinetobacter baumannii (CR-AB), 2 strains of carbapenem-resistant enterobacteriaceae (CRE) and 1 strain of multiple-drug/pan-drug resistant pseudomonas aeruginosa (MDR/PDR-PA) were identified. Among 2 690 strains of recipient pathogens, 73 strains of ESBL positive drug-resistant bacteria, 44 strains of CR-PA, 31 strains of CR-AB and 3 strains of MDR/PDR-PA were detected. One recipient developed donor-derived infection, 69 cases of pneumonia, 52 cases of urinary tract infection, 35 cases of abdominal infection and 2 cases of hematogenous infection were reported within postoperative 1 year. Gram-negative bacteria were resistant to certain antibiotics. Gram-positive bacteria were sensitive to vancomycin. Fungi were sensitive to amphotericin B. Conclusions Gram-negative bacteria are the main pathogens of SPK recipients, which are resistant to certain antibiotics. Empirical use of antibiotics can be delivered before culture results are obtained. Subsequently, sensitive antibiotics should be chosen according to the culture results to improve the survival rate of SPK recipients. -
图 2 受者菌群分布及构成比
Figure 2. Distribution and composition ratio of recipient bacterial flora
图 3 供者与受者MDRO分布特征
Figure 3. Distribution characteristics of MDRO in donors and recipients
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