器官移植患者院内感染病原体分布及其药敏分析
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摘要
目的分析器官移植患者院内感染病原体的分布及耐药性,为器官移植患者院内感染的治疗提供依据。方法收集2016年1月至2017年12月海军军医大学(第二军医大学)长海医院149例器官移植患者的临床样本。使用VITEK 2 Compact全自动微生物分析仪或Microflex基质辅助激光解析飞行时间质谱仪进行细菌鉴定。使用VITEK 2 Compact全自动微生物分析仪进行细菌药敏试验,使用ATB Fungus 3药敏试剂盒进行真菌药敏试验。结果器官移植患者感染的病原体主要来源于冲洗液样本(42.3%,101/239)。149例患者中共分离出239株病原菌,其中革兰阴性菌135株(56.5%)、革兰阳性菌77株(32.2%)、真菌27株(11.3%)。革兰阴性菌中肺炎克雷伯菌的检出率最高(13.8%,33/239),且其对哌拉西林等常见抗菌药物的耐药率普遍偏高(耐药率均>50.0%),呈多重耐药趋势;大肠埃希菌对碳青霉烯类药物的敏感性高(耐药率均<5.0%);鲍曼不动杆菌对碳青霉烯类药物的耐药率均高达81.0%。革兰阳性菌中肠球菌对青霉素、氨苄西林等常见抗菌药的耐药率为40.0%~77.2%,但未发现其对利奈唑胺及万古霉素耐药。真菌对常用抗真菌药物的敏感率均高于80.0%,其对伏立康唑的敏感性最高(96.3%)。结论器官移植患者院内感染病原菌主要为革兰阴性菌,肺炎克雷伯菌为主要致病菌,且呈现多重耐药趋势。革兰阳性菌对利奈唑胺及万古霉素敏感。真菌对常用抗真菌药物的敏感性较好。
Objective To investigate the distribution and drug susceptibility profile of pathogens causing nosocomial infection in organ transplant patients, so as to provide a basis for clinical diagnosis and treatment. Methods The clinical samples were collected from 149 organ transplant patients in Changhai Hospital of Navy Medical University(Second Military Medical University) between Jan. 2016 and Dec. 2017. The isolates were identified using VITEK 2 Compact automatic microorganism analyzer system or Microflex matrix-assisted laser desorption ionization-time of flight mass spectrometry. The susceptibility test for bacteria was carried out by VITEK 2 Compact automatic microorganism analyzer system, and the susceptibility test for fungus was carried out by ATB Fungus 3 susceptibility kit. Results Most pathogenic specimens were derived from flushing fluid samples(42.3%, 101/239). A total of 239 strains of pathogens were isolated from 149 patients, including 135(56.5%) of Gram-negative pathogens, 77(32.2%) of Gram-positive pathogens, and 27(11.3%) of fungi. Klebsiella pneumoniae was the most found Gram-negative pathogens(13.8%, 33/239), and its resistance to common antibiotics, such as piperacillin, was generally high with the resistance incidence being more than 50.0% and it had a tendency of multi-drug resistance. Escherichia coli had high sensitivity to carbapenems, with incidence of drug resistance being less than 5.0%. Acinetobacter baumannii had high resistance to carbapenems, with incidence of drug resistance being 81.0%. Among Gram-positive pathogens, Enterococcus had 40.0%-77.2% resistance incidence to penicillin and ampicillin, but was sensitive to linezolid and vancomycin. The sensitivity of fungi for most antifungal agents was higher than 80.0%, especially for voriconazole(96.3%). Conclusion Gram-negative pathogens are the primary pathogens causing nosocomial infection in organ transplant patients. Klebsiella pneumoniae is the main pathogen and has a tendency of multi-drug resistance. Grampositive pathogens are susceptible to linezolid and vancomycin. Fungi are susceptible to commonly used antifungal agents.
Objective To investigate the distribution and drug susceptibility profile of pathogens causing nosocomial infection in organ transplant patients, so as to provide a basis for clinical diagnosis and treatment. Methods The clinical samples were collected from 149 organ transplant patients in Changhai Hospital of Navy Medical University(Second Military Medical University) between Jan. 2016 and Dec. 2017. The isolates were identified using VITEK 2 Compact automatic microorganism analyzer system or Microflex matrix-assisted laser desorption ionization-time of flight mass spectrometry. The susceptibility test for bacteria was carried out by VITEK 2 Compact automatic microorganism analyzer system, and the susceptibility test for fungus was carried out by ATB Fungus 3 susceptibility kit. Results Most pathogenic specimens were derived from flushing fluid samples(42.3%, 101/239). A total of 239 strains of pathogens were isolated from 149 patients, including 135(56.5%) of Gram-negative pathogens, 77(32.2%) of Gram-positive pathogens, and 27(11.3%) of fungi. Klebsiella pneumoniae was the most found Gram-negative pathogens(13.8%, 33/239), and its resistance to common antibiotics, such as piperacillin, was generally high with the resistance incidence being more than 50.0% and it had a tendency of multi-drug resistance. Escherichia coli had high sensitivity to carbapenems, with incidence of drug resistance being less than 5.0%. Acinetobacter baumannii had high resistance to carbapenems, with incidence of drug resistance being 81.0%. Among Gram-positive pathogens, Enterococcus had 40.0%-77.2% resistance incidence to penicillin and ampicillin, but was sensitive to linezolid and vancomycin. The sensitivity of fungi for most antifungal agents was higher than 80.0%, especially for voriconazole(96.3%). Conclusion Gram-negative pathogens are the primary pathogens causing nosocomial infection in organ transplant patients. Klebsiella pneumoniae is the main pathogen and has a tendency of multi-drug resistance. Grampositive pathogens are susceptible to linezolid and vancomycin. Fungi are susceptible to commonly used antifungal agents.
引文
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[5]程艳爽,吕少诚,万涛,何蕾,徐明月,张雯雯,等.肝移植患者术后感染病原菌分布及耐药性分析[J].中华医院感染学杂志,2013,23:2221-2223.
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[8]FARRUGIA D,CHESHIRE J,MAHBOOB S,BEGAJI,KHOSLA S,RAY D,et al.Mortality after pediatric kidney transplantation in England-a population-based cohort study[J].Pediatr Transplant,2014,18:16-22.
[9]刘建明,杨永洁,刘大钺,林澜溪,黄美清.肝移植术后医院感染流行特征分析[J].中华医院感染学杂志,2011,19:4022-4024.
[10]MUKHTAR A,ABDELAAL A,HUSSEIN M,DABOUSH,FAWZY I,OBAYAH G,et al.Infection complications and pattern of bacterial resistance in living-donor liver transplantation:a multicenter epidemiologic study in Egypt[J].Transplant Proc,2014,46:1444-1447.
[11]吴金道,母小新,韩国勇,秦建杰,邵文雨,陆森,等.2012-2015年1 380株肝移植术后感染病原菌的分布及耐药性分析[J].现代药物与临床,2015,30:1546-1549.
[12]VOGT A,REUKEN P A,STENGEL S,STALLMACHA,BRUNS T.Dual-sugar tests of small intestinal permeability are poor predictors of bacterial infections and mortality in cirrhosis:a prospective study[J].World JGastroenterol,2016,22:3275-3284.
[13]FISHMAN J A,GROSSI P A.Donor-derived infectionthe challenge for transplant safety[J].Nat Rev Nephrol,2014,10:663-672.
[14]FISCHER S A,LU K;AST Infectious Diseases Community of Practice.Screening of donor and recipient in solid organ transplantation[J].Am J Transplant,2013,13(Suppl 4):9-21.
[15]汪复,朱德妹,胡付品,蒋晓飞,胡志东,李全,等.2012年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2013,13:321-330.
[16]晏群,李军,李虹玲,邬靖敏,邹明祥,刘文恩.2011年湘雅医院临床分离病原菌分布及耐药性分析[J].中国病原生物学杂志,2012,7:539-543.
[17]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.
[18]SHOHAM S,MARR K A.Invasive fungal infections in solid organ transplant recipients[J].Future Microbiol,2012,7:639-655.
[19]和丽佳,吕罕鲜,雷雅燕.白色假丝酵母菌及其相关基因的研究进展[J].国际口腔医学杂志,2013,40:90-93.
[2]HOLLYER I,ISON M G.The challenge of urinary tract infections in renal transplant recipients[J/OL].Transpl Infect Dis,2018,20:e12828.doi:10.1111/tid.12828.
[3]尚红,王毓三,申子瑜.全国临床检验操作规程[M].4版.北京:人民卫生出版社,2014:569-570.
[4]KHAN M S,MALIK A,AHMAD I.Anti-candidal activity of essential oils alone and in combination with amphotericin B or fluconazole against multi-drug resistant isolates of Candida albicans[J].Med Mycol,2012,50:33-42.
[5]程艳爽,吕少诚,万涛,何蕾,徐明月,张雯雯,等.肝移植患者术后感染病原菌分布及耐药性分析[J].中华医院感染学杂志,2013,23:2221-2223.
[6]XU L,XU M Q,YAN L N,LI B,WEN T F,WANGW T.Causes of mortality after liver transplantation:a single center experience in mainland China[J].Hepatogastroenterology,2012,59:481-484.
[7]CHAVERS B M,SOLID C A,GILBERTSON D T,COLLINS A J.Infection-related hospitalization rates in pediatric versus adult patients with end-stage renal disease in the United States[J].J Am Soc Nephrol,2007,18:952-959.
[8]FARRUGIA D,CHESHIRE J,MAHBOOB S,BEGAJI,KHOSLA S,RAY D,et al.Mortality after pediatric kidney transplantation in England-a population-based cohort study[J].Pediatr Transplant,2014,18:16-22.
[9]刘建明,杨永洁,刘大钺,林澜溪,黄美清.肝移植术后医院感染流行特征分析[J].中华医院感染学杂志,2011,19:4022-4024.
[10]MUKHTAR A,ABDELAAL A,HUSSEIN M,DABOUSH,FAWZY I,OBAYAH G,et al.Infection complications and pattern of bacterial resistance in living-donor liver transplantation:a multicenter epidemiologic study in Egypt[J].Transplant Proc,2014,46:1444-1447.
[11]吴金道,母小新,韩国勇,秦建杰,邵文雨,陆森,等.2012-2015年1 380株肝移植术后感染病原菌的分布及耐药性分析[J].现代药物与临床,2015,30:1546-1549.
[12]VOGT A,REUKEN P A,STENGEL S,STALLMACHA,BRUNS T.Dual-sugar tests of small intestinal permeability are poor predictors of bacterial infections and mortality in cirrhosis:a prospective study[J].World JGastroenterol,2016,22:3275-3284.
[13]FISHMAN J A,GROSSI P A.Donor-derived infectionthe challenge for transplant safety[J].Nat Rev Nephrol,2014,10:663-672.
[14]FISCHER S A,LU K;AST Infectious Diseases Community of Practice.Screening of donor and recipient in solid organ transplantation[J].Am J Transplant,2013,13(Suppl 4):9-21.
[15]汪复,朱德妹,胡付品,蒋晓飞,胡志东,李全,等.2012年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2013,13:321-330.
[16]晏群,李军,李虹玲,邬靖敏,邹明祥,刘文恩.2011年湘雅医院临床分离病原菌分布及耐药性分析[J].中国病原生物学杂志,2012,7:539-543.
[17]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.
[18]SHOHAM S,MARR K A.Invasive fungal infections in solid organ transplant recipients[J].Future Microbiol,2012,7:639-655.
[19]和丽佳,吕罕鲜,雷雅燕.白色假丝酵母菌及其相关基因的研究进展[J].国际口腔医学杂志,2013,40:90-93.