公民器官捐献供者感染现状与应对的回顾性研究
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摘要
目的探讨分析器官捐献供者感染的临床特点及应对措施,为感染供者的器官安全应用提供证据支持。方法回顾性分析2015年1月1日至2018年12月31日首都医科大学附属北京佑安医院肝移植中心93例器官捐献供者的资料,总结其感染特点并采取加强供体感染监测和早期积极预防或治疗的措施。结果 93例供体共分离出50例菌株,检出率最高的为铜绿假单胞菌12例(24%)和多重耐药菌株11例(22%)。梅毒抗体阳性4例,EB病毒感染2例,丙肝抗体阳性1例,HBsAg阳性1例。结论供体感染具有发生率高、耐药菌检出率高、耐药菌引发供体来源感染病死率高等特点,临床应对供、受者严密监测并早期预防或治疗,完善以器官捐献为中心的信息共享来降低供体来源感染的风险。
Objective To explore the clinical characteristics and counter measures of organ donor infection, and provide evidence support for in-depth discussion of organ safety application problems of infected donors. Methods A retrospective study was conducted to analyze the clinical data of 93 donors who were included in the civic organ donors from 2015 to 2018. Clinical features and measures to enhance donor infection surveillance and early active prevention or treatment were summarized. Results A total of 50 strains were isolated from 93 donors, and the highest detection rate was Pseudomonas aeruginosa in 12 cases(24%) and multidrug resistant strains in 11 cases(22%). There were four cases of syphilis antibody positive, two cases of EB virus infection, one case of hepatitis C antibody positive and one case of HBsAg positive. Conclusions Donor infection has the characteristics of high incidence, high detection rate of drug-resistant bacteria and high fatality rate of donor infection caused by drug-resistant bacteria. Therefore, both the donor and the recipient need to be closely monitored and early prevented or treated. Information sharing focuses on organ donation to reduce the risk of infection from donor sources.
Objective To explore the clinical characteristics and counter measures of organ donor infection, and provide evidence support for in-depth discussion of organ safety application problems of infected donors. Methods A retrospective study was conducted to analyze the clinical data of 93 donors who were included in the civic organ donors from 2015 to 2018. Clinical features and measures to enhance donor infection surveillance and early active prevention or treatment were summarized. Results A total of 50 strains were isolated from 93 donors, and the highest detection rate was Pseudomonas aeruginosa in 12 cases(24%) and multidrug resistant strains in 11 cases(22%). There were four cases of syphilis antibody positive, two cases of EB virus infection, one case of hepatitis C antibody positive and one case of HBsAg positive. Conclusions Donor infection has the characteristics of high incidence, high detection rate of drug-resistant bacteria and high fatality rate of donor infection caused by drug-resistant bacteria. Therefore, both the donor and the recipient need to be closely monitored and early prevented or treated. Information sharing focuses on organ donation to reduce the risk of infection from donor sources.
引文
[1]Lewis JD,Sifri CD.Multidrug-resistant bacterial donor-derived infections in solid organ transplantation[J].Curr Infect Dis Rep,2016,18:18.
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[8]Oguido AP,Casella AM,Hofling-Lima AL,et al.Pseudomonas aeruginosa endophthalmitis after penetrating keratoplasty transmitted from the same donor to two recipients confirmed by pulsed-field gel electrophoresis[J].J Clin Microbiol,2011,49:3346-3347.
[9]Orlando G,Di Cocco P,Gravante G,et al.Fatal hemorrhage in two renal graft recipients with multi-drug resistant Pseudomonas aeruginosa infection[J].Transpl Infect Dis,2009,11:442-447.
[10]中华医学会器官移植学分会,中华预防医学会医院感染控制学分会,复旦大学华山医院抗生素研究所.中国实体器官移植供者来源感染防控专家共识(2018版)[J].中华器官移植杂志,2018,39:41-52.
[11]Bucher JN,Schoenberg MB,Freytag I,et al.Donor-derived tuberculosis after solid organ transplantation in two patients and a staff member[J].Infection,2016,44:365-370.
[12]Green M,Covington S,Taranto S,et al.Donor-derived transmission events in 2013:a report of the Organ Procurement Transplant Network Ad Hoc Disease Transmission Advisory Committee[J].Transplantation,2015,99:282-287.
[13]Gomez CA,Singh N.Donor-derived filamentous fungal infectionsin solidorgan transplant recipients[J].Curr Opin Infect Dis,2013,26:309-316.
[14]American Society of Transplantation.Solid organ transplantation from hepatitis B virus-positive donors:consensus guidelines for recipient management[J].Am J Transplant,2015,15:1162-1172.
[15]Bari K,Luckett K,Kaiser T,et al.Hepatitis C transmission from seropositive,nonviremic donors to non-hepatitis C liver transplant recipients[J].Hepatology,2018,67:1673-1682.
[2]Cohen J,Michowiz R,Ashkenazi T,et al.Successful organ transplantation from donors with Acinetobacter baumannii septic shock[J].Transplantation,2006,81:853-855.
[3]Andini R,Agrusta FM,Mattucci I,et al.Recipient-born bloodstream infection due to extensively drug-resistant Acinetobacter baumannii after emergency heart transplant:report of a case and review of the literature[J].Infection,2015,43:609-613.
[4]Ovia?o M,Bou G.Imipenem-avibactam:a novel combination for the rapid detection of carbapenemase activity in Enterobacteriaceae and Acinetobacter baumannii by matrix-assisted laser desorption ionization-time of flight mass spectrometry[J].Diagn Microbiol Infect Dis,2017,87:129-132.
[5]Escolà-VergéL,Los-Arcos I,JoséGonzález-López J,et al.Successful liver transplantation despite donor-transmitted ESBL-producing Klebsiella pneumoniae infection:case report and review of the literature[J].Transpl Infect Dis,2017,19:e12743.
[6]Mills JP,Wilck MB,Weikert BC,et al.Successful treatment of a disseminated infection with extensively drug-resistant Klebsiella pneumoniae in a liver transplant recipient with a fosfomycin-based multidrug regimen[J].Transpl Infect Dis,2016,18:777-781.
[7]Simkins J,Muggia V.Favorable outcome in a renal transplant recipient with donor-derived infection due to multidrug-resistant Pseudomonas aeruginosa[J].Transpl Infect Dis,2012,14:292-295.
[8]Oguido AP,Casella AM,Hofling-Lima AL,et al.Pseudomonas aeruginosa endophthalmitis after penetrating keratoplasty transmitted from the same donor to two recipients confirmed by pulsed-field gel electrophoresis[J].J Clin Microbiol,2011,49:3346-3347.
[9]Orlando G,Di Cocco P,Gravante G,et al.Fatal hemorrhage in two renal graft recipients with multi-drug resistant Pseudomonas aeruginosa infection[J].Transpl Infect Dis,2009,11:442-447.
[10]中华医学会器官移植学分会,中华预防医学会医院感染控制学分会,复旦大学华山医院抗生素研究所.中国实体器官移植供者来源感染防控专家共识(2018版)[J].中华器官移植杂志,2018,39:41-52.
[11]Bucher JN,Schoenberg MB,Freytag I,et al.Donor-derived tuberculosis after solid organ transplantation in two patients and a staff member[J].Infection,2016,44:365-370.
[12]Green M,Covington S,Taranto S,et al.Donor-derived transmission events in 2013:a report of the Organ Procurement Transplant Network Ad Hoc Disease Transmission Advisory Committee[J].Transplantation,2015,99:282-287.
[13]Gomez CA,Singh N.Donor-derived filamentous fungal infectionsin solidorgan transplant recipients[J].Curr Opin Infect Dis,2013,26:309-316.
[14]American Society of Transplantation.Solid organ transplantation from hepatitis B virus-positive donors:consensus guidelines for recipient management[J].Am J Transplant,2015,15:1162-1172.
[15]Bari K,Luckett K,Kaiser T,et al.Hepatitis C transmission from seropositive,nonviremic donors to non-hepatitis C liver transplant recipients[J].Hepatology,2018,67:1673-1682.