小儿活体肝移植术后细菌感染种类、药物敏感性及治疗措施分析.doc

儿童活体肝移植术后细菌感染及药物敏感性分析 蒲从伦，李英存，张明满，金先庆，郭春宝，康 权 （重庆医科大学附属儿童医院肝胆外科，重庆 400014） 摘 要：目的 探讨儿童活体肝移植术后常见细菌感染种类及药物敏感性。方法 对我院2006年6月至2009年3月共22例活体肝移植患儿术后细菌感染情况进行回顾性分析，总结常见细菌感染种类，并对其药物敏感试验结果、抗生素的选择进行分析。结果 术后20/22(91%)患儿存在不同程度的显性及隐性感染；呼吸道（95%）及腹腔（55%）为最常见感染部位；铜绿假单胞菌、鲍曼不动杆菌为呼吸道感染常见致病菌；表皮葡萄球菌、屎肠球菌为腹腔感染常见致病菌；药敏结果显示：环丙沙星、左氧氟沙星、加替沙星及多粘菌素对铜绿假单胞菌敏感；泰能、多粘菌素及美洛配能对鲍曼不动杆菌敏感；万古霉素、利奈唑烷及替考拉宁对表皮葡萄球菌、屎肠球菌敏感。结论 儿童活体肝移植术后细菌感染较为多见，以呼吸道及腹腔为主。其中铜绿假单胞菌、表皮葡萄球菌、鲍曼不动杆菌、屎肠球菌为常见致病菌。临床可选用左氧氟沙星治疗铜绿假单胞菌感染，泰能控制鲍曼不动杆菌感染，万古霉素可同时用于表皮葡萄球菌、屎肠球菌感染。 关键词：肝移植；活体供者；儿童；细菌感染；微生物敏感性试验CATEGORIES AND SENSITIVITY OF BACTERIAL INFECTION AFTER PEDIATRIC LIVING DONOR LIVER TRANSPLANTATION PU Cong-Lun, LI Ying-Cun, ZHANG Ming-Man, JIN Xian-Qing, GUO Chun-Bao Kang Quan (Department of hepato-biliary surgery, Children’s hospital, Chongqing Medical University, Chongqing, 400014 China) Abstract: Objective To investigate the categories and sensitivity of bacterial infection after pediatric living donor liver transplantation(LDLT). Methods Twenty two cases were operated for LDLT in our hospital from Jun 2006 to March 2009. Analyses were done retrospectively for the categories and sensitivity of bacterial infection after LDLT. Results Twenty cases among 22(91%) had bacterial infections after LDLT. Respiratory tract (95%) and abdominal cavity (55%) were the most common system involved. Pseudomonas aeruginosa and acinetobacter baumannii were common in respiratory tract, while staphylococcus epidermidis and enterococcus faecium were responsible for infection of abdominal cavity. According to the sensitive test, pseudomonas aeruginosa was sensitive to ciprofloxaxin, levofloxacin, gatifloxacin and colistin; acinetobacter baumannii was sensitive to imipenem, colistin and meropenem; staphylococcus epidermidis and enterococcus faecium infections were sensitive to vancomycin, linezolid and teicoplanin. Conclusions Bacterial infection is very common after pediatric LDLT, especially in respiratory tract and abdominal cavity. Pseudom