肝移植术后大肠埃希菌血行感染耐药及危险因素分析.pdfVIP

肝移植术后大肠埃希菌血行感染耐药 及危险因素分析 邰强 何晓顺 胡安斌 巫林伟 鞠卫强 朱晓峰 王东平 王国栋 马毅 郭志勇 黄洁夫 [摘要] 目的 探讨肝移植术后血行感染中大肠埃希菌的耐药、临床结果及危险因素。方法 回顾分析1993年1月至2010年5月，中山大学附属第一医院移植科肝移植术后血行感染中大肠埃 希菌患者资料，对患者的资料(如:抗生素耐药、术式及危险因素)进行分类统计。结果 695例肝移 植患者中，83例(7.6％)88次出现革兰阴性球菌血行感染，以大肠埃希菌(23例)最为常见。大肠埃 希菌对碳青酶烯类抗生素均为100％敏感，对哌拉西林/他唑巴坦耐药率在5％以下，而对环丙沙星、 庆大霉素、氨苄西林/克拉维酸耐药率基本都在60％以上。针对肝移植术后大肠埃希菌血行感染的 危险因素分析发现，施行胆肠吻合术(P＜0. 001)和胆道并发症(P＜0. 001)是出现大肠埃希菌血行 感染的危险因素。感染后15 d病死率大肠埃希菌血行感染高于非大肠埃希菌血行感染(P=0. 01)， 血行感染后30 d、1年病死率差异无统计学意义。结论 肝移植术后大肠埃希菌血行感染，对多种抗 生素耐药，但对碳青酶烯类、哌拉西林/他唑巴坦敏感。施行胆肠吻合术、胆道并发症是出现肝移植术 后大肠埃希菌血行感染的危险因素。肝移植术后大肠埃希菌血行感染后的15 d病死率显著增加。 埃希氏菌属;危险因素;血行感染;死亡率 A 17-year study of bloodstream Escherichia coli infection after liver transplantation: resistance rate, risk factor and mortality TAI QiangHE Xiao-shun HU An-bin WU Lin-weiJU Wei-qiang ZHU Xiao-feng WANG Dong-ping WANG Guo-dong MA Yi GUO Zhi-yong HUANG Jie-fu Organ Transplantation Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China [ Abstract] Objective To explore the resistance rate, risk factors and mortality of Escherichia coli bloodstream infections (BSI) after liver transplantation. Methods From January 1993 to May 2010, a retrospective analysis of Escherichia coli in liver transplants were conducted. Results A total of 88 BSI occurred in 83/695 patients and Escherichia coli ( n = 23 ) was most commonly found. Carbapenem and piperacillin-tazobactam were the most consistently active against Escherichia coli while the resistance rate to enterococcus for ciprofloxacin, gentamycin, ampicillin-clavulanic acid was over 60％. Univariate analysis identified the following variables as risk factors for Escherichia coli bacteremia: cholangioenterostomy ( P ＜0.001 ) and ductal complications ( P ＜ 0.001 ). Escherichia coli bloodstream infection could increase the mortality at 15 days after bloodstream infection. No significant difference in mortality occurred at 30 days and 1 year after enterococca