肝脏移植术后医院感染状况分析及防控对策
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摘要
目的肝移植术后医院感染是目前临床面临的重要挑战,本研究通过分析肝植术后患者医院感染的情况,为有效预防和控制术后院内感染提供依据。方法采用回顾性调查病例的分析方法,对中山大学附属第三医院2014-05-01-2016-09-30肝脏移植术后医院感染病例进行综合调查分析。结果 230例肝脏移植患者中,144例术后发生医院感染,感染率为62.6%。呼吸道感染最多,占69.2%,胆道及血液感染分别居第2、3位。肝癌患者的感染发生频率最高(69.05%),其次为急性肝衰竭(66.67%)、肝炎后肝硬化(64.39%)和自身免疫性肝硬化(60.00%),各组感染率分布差异无统计学意义,χ~2=4.479,P=0.483。144例医院感染患者共分离出260株病原菌,鲍曼不动杆菌(25.77%)、嗜麦芽黄单胞菌(15.00%)和铜绿假单胞菌(13.46%)居前3位。结论肝脏移植患者术后医院感染率高,感染部位以呼吸系统及胆道为主,医院感染的防控对策是了解术前供体肝脏情况,减少或缩短侵入性器械的使用,加强无菌意识、手卫生意识及术后基础护理。
OBJECTIVE Hospital infection after liver transplantation has been an important clinical challenge for a long time.The analysis of hospital infection after liver transplantation will effectively provide a basis for prevention and control of postoperative nosocomial infection in advance.METHODS Retrospective investigation was used to analyze the hospital infection after liver transplantation in the hospital from May 1,2014 to September 30,2016.RESULTS Among the 230 cases of liver transplantation,144 cases had nosocomial infection after operation,and the infection rate was62.6%.Respiratory tract infection was the most common,accounting for 69.2%,and infections in biliary tract and blood were the second,third respectively.The highest incidence of infection was found in HCC patients(69.05%),followed by patients with acute liver failure(66.67%),posthepatitic cirrhosis(64.39%)and autoimmune cirrhosis(60.00%).There was no significant difference in the distribution of infection rates among the groups,χ~2=4.479,P=0.483.A total of 260 pathogenic bacteria were isolated from 144 patients with nosocomial infection.Acinetobacter baumannii(25.77%),Xanthomonas maltophilia(15.00%)and Pseudomonas aeruginosa(13.46%)were the top three bacteria.CONCLUSIONS The hospital infection rate of patients after liver transplantation is high.The priority infection sites are in the respiratory system and biliary tract.The prevention and control measures to hospital infection are mainly to know the preoperative conditions of donor liver,to reduce or shorten the use of invasive devices,to strengthen the consciousness of sterile and hand hygiene and the postoperative care for patients must be further improved.
OBJECTIVE Hospital infection after liver transplantation has been an important clinical challenge for a long time.The analysis of hospital infection after liver transplantation will effectively provide a basis for prevention and control of postoperative nosocomial infection in advance.METHODS Retrospective investigation was used to analyze the hospital infection after liver transplantation in the hospital from May 1,2014 to September 30,2016.RESULTS Among the 230 cases of liver transplantation,144 cases had nosocomial infection after operation,and the infection rate was62.6%.Respiratory tract infection was the most common,accounting for 69.2%,and infections in biliary tract and blood were the second,third respectively.The highest incidence of infection was found in HCC patients(69.05%),followed by patients with acute liver failure(66.67%),posthepatitic cirrhosis(64.39%)and autoimmune cirrhosis(60.00%).There was no significant difference in the distribution of infection rates among the groups,χ~2=4.479,P=0.483.A total of 260 pathogenic bacteria were isolated from 144 patients with nosocomial infection.Acinetobacter baumannii(25.77%),Xanthomonas maltophilia(15.00%)and Pseudomonas aeruginosa(13.46%)were the top three bacteria.CONCLUSIONS The hospital infection rate of patients after liver transplantation is high.The priority infection sites are in the respiratory system and biliary tract.The prevention and control measures to hospital infection are mainly to know the preoperative conditions of donor liver,to reduce or shorten the use of invasive devices,to strengthen the consciousness of sterile and hand hygiene and the postoperative care for patients must be further improved.
引文
[1]林栋栋,刘晋宁.肝移植围术期感染的处理[J].北京医学,2017,39(9):895-896.
[2] Kim SI,Kim YJ,Choi JY,et al.Strategies to reduce infectious complication using epidemiologic data analysis in liver transplant recipients[J].Transplant Proc,2013,45(8):3061-3064.
[3] Fort NM,Aichmair A,Miller AO,et al.L5-S1Achromobacter xylosoxidans infection secondary to oxygen-ozone therapy for the treatment of lumbosacral disc herniation:a case report and review of the literature[J].Spine,2014,39(6):E413-E416.
[4] Niewinsk G,Raszeja-Wyszomirska J,Glowczynska R,et al.Risk factors of prolonged ICU stay in liver transplant recipients in a single-center experience[J].Transplant Proc,2018,50(7):2014-2017.
[5]徐潜,张璟.医院感染控制发展现状及存在问题[J].中国消毒学杂志,2012,29(8):712-714.
[6] Troxell ML,Lanciault C.Practical applications in immunohistochemistry:Evaluation of rejection and infection in organ transplantation[J].Arch Pathol Lab Med,2016,140(9):910-925.
[7]杨慧宁,曹力,王鲜平,等.肝移植受体医院感染危险因素研究[J].中华医院感染学杂志,2011,21(1):52-54.
[8]吕少诚,王苑,潘冰,等.肝移植术后肺部感染的诊治及其危险因素[J].中华肝胆外科杂志,2018,24(6):371-375.
[9]吕少诚,李立新,赵昕,等.同种异体肝移植术后腹腔感染的病原菌分析及特点[J].北京医学,2017,39(10):995-998.
[10]梁家隐,李晓杰,席云,等.肝脏移植后胆道感染病原菌分布与耐药性分析[J].实用医学杂志,2015,31(9):1529-1531.
[11] Yamanouchi K,Eguchi S,Takatsuki M,et al.Management of fungal colonization and infection after living donor liver transplantation[J].Hepatogastroenterology,2010,57(101):852-857.
[12]李恒,李飞,吴君,等.某综合医院住院患者医院感染监测报告[J].中国消毒学杂志,2015,32(5):475-477.
[13]谢秀华,姜英俊,解曼,等.肝移植后早期受者发生感染的危险因素及病原学分析[J].中华器官移植杂志,2017,38(4):200-205.
[14]侯艺蕾,戴茹,邹翠美,等.某医院连续6年医院感染病原菌及其耐药性监测[J].中国消毒学杂志,2016,39(9):882-884.
[15] Bucheli E,Kralidis G,Boggian K,et al.Impact of enterococcal colonization and infection in solid organ transplantation recipients from the Swiss transplant cohort study[J].Transpl Infect Dis,2014,16(1):26-36.
[2] Kim SI,Kim YJ,Choi JY,et al.Strategies to reduce infectious complication using epidemiologic data analysis in liver transplant recipients[J].Transplant Proc,2013,45(8):3061-3064.
[3] Fort NM,Aichmair A,Miller AO,et al.L5-S1Achromobacter xylosoxidans infection secondary to oxygen-ozone therapy for the treatment of lumbosacral disc herniation:a case report and review of the literature[J].Spine,2014,39(6):E413-E416.
[4] Niewinsk G,Raszeja-Wyszomirska J,Glowczynska R,et al.Risk factors of prolonged ICU stay in liver transplant recipients in a single-center experience[J].Transplant Proc,2018,50(7):2014-2017.
[5]徐潜,张璟.医院感染控制发展现状及存在问题[J].中国消毒学杂志,2012,29(8):712-714.
[6] Troxell ML,Lanciault C.Practical applications in immunohistochemistry:Evaluation of rejection and infection in organ transplantation[J].Arch Pathol Lab Med,2016,140(9):910-925.
[7]杨慧宁,曹力,王鲜平,等.肝移植受体医院感染危险因素研究[J].中华医院感染学杂志,2011,21(1):52-54.
[8]吕少诚,王苑,潘冰,等.肝移植术后肺部感染的诊治及其危险因素[J].中华肝胆外科杂志,2018,24(6):371-375.
[9]吕少诚,李立新,赵昕,等.同种异体肝移植术后腹腔感染的病原菌分析及特点[J].北京医学,2017,39(10):995-998.
[10]梁家隐,李晓杰,席云,等.肝脏移植后胆道感染病原菌分布与耐药性分析[J].实用医学杂志,2015,31(9):1529-1531.
[11] Yamanouchi K,Eguchi S,Takatsuki M,et al.Management of fungal colonization and infection after living donor liver transplantation[J].Hepatogastroenterology,2010,57(101):852-857.
[12]李恒,李飞,吴君,等.某综合医院住院患者医院感染监测报告[J].中国消毒学杂志,2015,32(5):475-477.
[13]谢秀华,姜英俊,解曼,等.肝移植后早期受者发生感染的危险因素及病原学分析[J].中华器官移植杂志,2017,38(4):200-205.
[14]侯艺蕾,戴茹,邹翠美,等.某医院连续6年医院感染病原菌及其耐药性监测[J].中国消毒学杂志,2016,39(9):882-884.
[15] Bucheli E,Kralidis G,Boggian K,et al.Impact of enterococcal colonization and infection in solid organ transplantation recipients from the Swiss transplant cohort study[J].Transpl Infect Dis,2014,16(1):26-36.