肾移植受者术后医院感染流行病学单中心分析

谈宜斌; 金学兰; 李源; 吴松杰; 王莹; 田佳; 宋世会; 王彦峰

doi:10.3969/j.issn.1674-7445.2019.04.013

肾移植受者术后医院感染流行病学单中心分析

doi: 10.3969/j.issn.1674-7445.2019.04.013

430071 武汉大学中南医院医院感染管理办公室（谈宜斌、金学兰、李源、吴松杰、王莹、田佳、宋世会）；肝胆疾病研究院（王彦峰）

基金项目:

国家自然科学基金 81570079

详细信息

作者简介:
谈宜斌，女，1973年生，硕士，副主任护师，研究方向为医院感染管理，Email：846935789@qq.com

通讯作者:
王彦峰，男，1964年生，博士，主任医师，研究方向为肝胆疾病；Email：yanfengwang@whu.edu.cn

中图分类号: R617, R63
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- 被引次数: 0
出版历程
- 收稿日期: 2019-04-08
- 网络出版日期: 2021-01-19
- 刊出日期: 2019-07-15

Epidemiology of nosocomial infection in recipients after renal transplantation: a single-center analysis

Nosocomial Infection Management Office, Zhongnan Hospital of Wuhan University, Wuhan 430071, China

More Information

Corresponding author: Wang Yanfeng, Email:yanfengwang@whu.edu.cn

摘要

摘要: 目的探讨肾移植受者术后医院感染流行病学特点及其防控措施。方法 2014年1月至2017年12月对456例肾移植受者进行监测，分析肾移植术后医院感染情况，包括基本情况、感染部位、感染病原体类型。结果 456例肾移植受者中，发生医院感染78例（17.1%），术后感染时间为9（3~21）d。感染部位主要为下呼吸道、泌尿系统和血流感染。感染病原体类型包括葡萄球菌13株、屎肠球菌6株、真菌6株、嗜麦芽窄食单胞菌4株、鲍曼不动杆菌4株、铜绿假单胞菌4株、表皮葡萄球菌4株、肺炎克雷伯菌1株、大肠埃希菌1株、其他阴性菌9株。其中多重耐药菌感染11例（14%），死亡4例。结论肾移植受者术后医院感染发生率较高、术后发病早、多重耐药菌感染常见且病死率高，应充分做好术前准备、积极预防术后下呼吸道感染、规范实施多重耐药菌防治措施。
- 肾移植 /
- 真菌 /
- 细菌 /
- 医院感染 /
- 病原体 /
- 流行病学研究
Abstract: Objective To investigate the epidemiological characteristics of renal transplantation recipients, effective prevention and control measures. Methods A total of 456 renal transplant recipients were monitored from January 2014 to December 2017. Postoperative infection including baseline data, infection site and infectious pathogen type was analyzed. Results Among 456 renal transplant recipients, 78 cases (17.1%) developed nosocomial infection. Postoperative infection time was 9(3-21) d. Infection sites mainly included the lower respiratory tract, urinary system and blood infection. Infection pathogens consisted of Staphylococci (n=13), Enterococcus faecium (n=6), fungi (n=6), Stenotrophomonas maltophilia (n=4), Acinetobacter baumannii (n=4), Pseudomonas aeruginosa (n=4), Staphylococcus epidermidis (n=4), Klebsiella pneumoniae (n=1), Escherichia coli (n=1) and other negative bacteria (n=9). Among them, 11 cases (14%) were infected with multi-drug resistant bacteria, and 4 cases died. Conclusions In renal transplant recipients, the incidence of nosocomial infection is relatively high, with early postoperative onset, common multiple drug-resistant bacterial infection and high mortality. Preoperative preparations should be fully implemented, postoperative lower respiratory tract infection should be actively prevented and prevention and treatment measures for multidrug-resistant bacteria should be standardized.
- Renal transplantation /
- Fungus /
- Bacterium /
- Nosocomial infection /
- Pathogen /
- Epidemiological study

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表 1 78例肾移植受者术后感染部位的构成比

Table 1. Composition ratio of postoperative infection positions in 78 renal transplant recipients

感染部位	2014年		2015年		2016年		2017年		合计
感染部位	感染例次	构成比（%）	感染例次	构成比（%）	感染例次	构成比（%）	感染例次	构成比（%）	感染例次	构成比（%）
下呼吸道	12	57	13	57	12	55	5	19	42	45
泌尿系统	4	19	5	22	6	27	10	37	25	27
血流	5	24	2	9	3	14	5	19	15	16
腹腔	0	0	0	0	0	0	1	4	1	1
术后伤口	0	0	1	4	0	0	1	4	2	2
其他	0	0	2	9	1	5	4	15	7	8
合计	21	100	23	100	22	100	26	100	92	100

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表 2 78例肾移植受者术后感染病原体的构成比

Table 2. Composition ratio of postoperative infection pathogens in 78 renal transplant recipients

感染病原体	2014年		2015年		2016年		2017年		合计
感染病原体	菌株数	构成比（%）	菌株数	构成比（%）	菌株数	构成比（%）	菌株数	构成比（%）	菌株数	构成比（%）
鲍曼不动杆菌	1	5	1	9	1	14	1	8	4	8
铜绿假单胞菌	0	0	1	9	3	43	0	0	4	8
肺炎克雷伯菌	1	5	0	0	0	0	0	0	1	2
屎肠球菌	2	11	1	9	0	0	3	23	6	12
嗜麦芽窄食单胞菌	1	5	0	0	1	14	2	15	4	8
大肠埃希菌	1	5	0	0	0	0	0	0	1	2
表皮葡萄球菌	3	16	0	0	0	0	1	8	4	8
葡萄球菌	6	32	4	36	1	14	0	0	11	22
真菌	0	0	3	27	1	14	2	15	6	12
其他阴性菌	4	21	1	9	0	0	4	31	9	18
合计	19	100	11	100	7	100	13	100	50	100

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