摘要
目的感染是移植术后最常见的非心血管疾病死亡原因。文中分析和探讨肾移植受者围手术期感染的流行病学特征、危险因素以及预防性使用抗菌药物的合理性。方法回顾性分析2015年1月至2019年3月于东部战区总医院接受肾移植术的303例受者围手术期感染的发生率、类型、来源、病原菌分布情况及危险因素,并比较不同级别抗菌药物的预防效果。结果肾移植受者围手术期发生感染30例(9.90%),29例为医院感染(96.67%)。其中最常见的感染为肺部感染(12/30,40.00%),感染病原体主要为G-菌26株(66.67%)。心脏死亡器官捐献(DCD)肾移植受者围手术期感染发生率显著高于活体肾移植受者(12.78%vs 5.69%,χ2=4.114,P<0.05)。DCD肾移植围术期使用不同级别的抗菌药物预防,感染发生率差异无统计学意义(10.47%vs 14.89%,χ2=0.790,P=0.374)。Logistic回归分析表明,术中输血(OR=3.973,95%CI 1.092~14.455,P=0.036)、术后运用霉酚酸酯联合环孢素及激素的免疫抑制方案(OR=6.404,95%CI 1.216~33.717,P=0.028)是肾移植受者围手术期感染的独立危险因素。结论肾移植受者围手术期易并发术后感染,且多为医院感染。DCD肾移植受者比活体肾移植受者更易发生围手术期感染,且预防性使用高级别的抗菌药物不能有效降低围手术期感染发生率,需针对危险因素采取有效措施来降低感染发生率。
Objective Infection is the most common cause of non-cardiovascular death after transplantation.This paper is to analyze and explore infections of the epidemiological characteristics,risk factors for renal transplant recipients in perioperative and the rationality of prophylactic use of antibiotics.Methods It has analyzed retrospectively the incidence,type,source,distribution of pathogenic bacteria and risk factors of perioperative infection in 303 patients who received renal transplantation in the General Hospital of the Eastern Theater Command from January 2015 to March 2019,and has compared the preventive effects of different levels of antimicrobial agents.Results 30 patients(9.90%)were perioperative infection and 29 patients(96.67%)were nosocomial infection.The most common infection was pulmonary infection[12/30,40.00%],and the main infectious pathogen was 26 strains of G-bacteria(66.67%).The incidence of perioperative infection was significantly higher in DCD(Donation after Cardiac Death)renal transplant recipients than in living renal transplant recipients(12.78%vs 5.69%,P<0.05).During the perioperative period of DCD renal transplantation,it used different levels of antimicrobial prophylaxis,and there was no statistically significant difference in the incidence of infection(10.47%vs 14.89%,P=0.374).Logistic regression analysis showed that intraoperative blood transfusion(OR=3.973,95%CI 1.092-14.455,P=0.036)and postoperative immunosuppressive regimen of mycophenolate mofetil combined with cyclosporin and hormone(OR=6.404,95%CI 1.216-33.717,P=0.028)were independent risk factors for perioperative infection in renal transplant recipients.Conclusion Perioperative infections were more common in renal transplant recipients,and most of them were nosocomial.DCD kidney transplant recipients were more likely to have perioperative infection than living kidney transplant recipients,and prophylactic use of high-level antimicrobial agents could not effectively reduce the incidence of perioperative infection,so effective measures should be taken to reduce the incidence of infection according to risk factors.
作者
刘彦妤
岳慧杰
陈晨
程东瑞
李雪
王金泉
周国华
LIU Yan-yu;YUE Hui-jie;CHEN Chen;CHENG Dong-rui;LI Xue;WANG Jin-quan;ZHOU Guo-hua(Department of Clinical Pharmacy,Nanjing University School of Medicine/General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China;National Clinical Research Center of Kidney Diseases,Jinling Hospital,Nanjing University School of Medicine/General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China)
出处
《医学研究生学报》
CAS
北大核心
2020年第11期1181-1186,共6页
Journal of Medical Postgraduates
关键词
肾移植
围手术期
医院感染
抗菌药物
危险因素
kidney transplantation
perioperative period
nosocomial infection
antimicrobial agents
risk factors
