摘要
目的研究肝移植术后感染的主要病原菌及病原菌的耐药机制。方法采用K-B法检测术后主要病原菌的药敏情况;三维实验法检测主要阴性杆菌的超广谱β-内酰胺酶(ESBLs)、AmpC酶产酶情况;头孢硝基噻吩显色法检测肠球菌的β-内酰胺酶;琼脂稀释法检测Van基因。结果55例患者肝移植术后感染主要为革兰氏阴性杆菌,其对4种及4种以上抗生素的耐药率均超过40%。阴沟肠杆菌与大肠杆菌的ESBLs与AmpC酶检出率分别为32.4%、36.8%和33.8%、10.5%,同时产二种酶的检出率为24.3%、7.0%。粪肠球菌、屎肠球菌的β-内酰胺酶产酶率分别为8.8%、11.1%,对万古霉素的耐药率分别为11.2%、18.5%。结论肝移植术后主要病原菌对抗生素具有高耐药性与多重耐药性;ESBLs与AmpC酶是革兰氏阴性杆菌产生耐药的因素;耐万古霉素的肠球菌在肝移植术后的检出率增高应引起临床重视。
Objective To study the main infectious bacteria and their drug-resistance after liver transplantation. Methods K-B method was used to detect the susceptibility of agents of the main bacteria after liver transplantation. ESBLs and AmpC -lactamase among the main negative bacillus were detected by three-dimensional tests. β-1actamase and Van gene among Enteroeoccus were dectected by standard agar dilution susceptibility tests and Nitrocefin respectively. Results Among the main Gramnegative bacteria in 55 cases of infection following liver transplantation, the ratio of resistance to 4 or more antibiotic were all beyond 40%. The detectable rate of ESBLs and AmpC β-1actamases in Enterobacter cloacae and Escherichia coli was 32. 4% and 36. 8%, and 33.8% and 10, 5% respectively. Moreover, the detectable rate of both ESBLs and AmpC β-1actamases in Enterobacter cloacae and Escherichia coli was 24. 3% and 7. 0% repectively. 8.8% and 11.1% produced β-lactamases in Enterococcus faecalis and Enterococcusfaecium, with the ratio of resistance to Vancomycin being 11.2% and 18. 5% respectively. Conclusions The primary pathogens have the high and multiple resistance to antimicrobial after liver transplantation. ESBLs and AmpC β-lactamases were the main two factors of drug-resistance among Gram-negative bacillus, we should pay much attention to the high detectble rate of Enterococcus which are resistant to Vancomycin after liver transplantation.
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2005年第8期455-457,共3页
Chinese Journal of Organ Transplantation
基金
湖南省卫生厅基金资助项目(B2004-067)
关键词
肝移植
术后感染
病原菌
耐药性
Liver transplantation
Bacterial infection
Drug tolerance
