公民逝世后器官捐献感染性供者病原菌分布特点及肾移植受者预防策略——单中心经验总结

赖兴强; 陈丽; 张磊; 方佳丽; 李光辉; 徐璐; 何静雯; 马俊杰; 陈正

doi:10.3969/j.issn.1674-7445.2019.06.014

公民逝世后器官捐献感染性供者病原菌分布特点及肾移植受者预防策略——单中心经验总结

doi: 10.3969/j.issn.1674-7445.2019.06.014

510260 广州医科大学附属第二医院器官移植中心

基金项目:

国家自然科学基金青年科学基金项目 81601393

广州市高校教师科研项目 1201630506

详细信息

作者简介:
赖兴强，男，1984年生，博士，主治医师，研究方向为肾移植相关研究，Email：laixq1984@163.com

通讯作者:
陈正，男，1974年生，博士，教授，主任医师，研究方向为肾移植相关研究，Email：docchenzheng@163.com

中图分类号: R617, R619.3
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出版历程
- 收稿日期: 2019-07-03
- 网络出版日期: 2021-01-19
- 刊出日期: 2019-11-15

Distribution characteristics of pathogenic bacteria in infectious donors from organ donation after citizen's death and preventive strategies for renal transplant recipients: a single center experience

Department of Organ Transplantation, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China

More Information

Corresponding author: Chen Zheng, Email:docchenzheng@163.com

摘要

摘要: 目的探讨公民逝世后器官捐献供者感染病原菌分布特点及肾移植受者预防策略。方法回顾性分析412例公民逝世后器官捐献供者及对应803例受者临床资料，所有供者均行气道分泌物、尿液、血液及供肾灌洗液培养，观察公民逝世后器官捐献供者感染发生率、病原菌分布和构成比，根据供者重症监护室（ICU）住院时间、腹部外伤情况、体液培养结果等因素进行评分，受者根据评分采用不同的感染预防方案，分析供者来源性感染（DDI）的发生率及受者预后。结果 412例公民逝世后器官捐献供者中共有243例存在感染，感染率59.0%，共分离出病原菌456株，病原菌主要来源于气道分泌物（71.7%）。革兰阴性菌以肺炎克雷伯菌和鲍曼不动杆菌为主，革兰阳性菌以金黄色葡萄球菌为主，真菌主要为酵母型真菌。共有3例受者（分别接受来自2例供者的肾脏）发生DDI，发生率0.4%。结论公民逝世后器官捐献供者感染率较高，对供者感染风险进行分级评分，根据评分采取合理预防方案，可有效预防DDI。
- 公民逝世后器官捐献 /
- 肾移植 /
- 供者来源性感染 /
- 病原菌 /
- 气道分泌物 /
- 革兰阴性菌 /
- 革兰阳性菌
Abstract: Objective To investigate the distribution characteristics of pathogenic bacteria in infectious donors from organ donation after citizen's death and preventive strategies for renal transplant recipients. Methods Clinical data of 412 donors and 803 recipients from organ donation after citizen's death were retrospectively analyzed. All donors underwent culture of airway secretions, urine, blood and renal lavage fluid. The incidence rate of infection, distribution and composition ratio of pathogenic bacteria of donors from organ donation after citizen's death were observed. The scores of all donors were evaluated according to the length of intensive care unit (ICU) stay for donors, the situation of abdominal trauma and the results of body fluid culture, etc. According to the score, the recipients received different infection prevention regimes. The incidence rate of donor-derived infection (DDI) and clinical prognosis of the recipients were analyzed. Results A total of 243 donors were diagnosed with infection in 412 donors from organ donation after citizen's death with an infection rate of 59.0%. In total, 456 strains of pathogenic bacteria were isolated, mainly derived from the airway secretions (71.7%). Gram-negative bacteria dominantly consisted of Klebsiella pneumoniae and acinetobacter baumannii. Gram-positive bacteria mainly included staphylococcus aureus and fungus mainly included yeast-type fungus. Three recipients (kidneys from 2 donors respectively) developed DDI with an incidence rate of 0.4%. Conclusions The infection rate of donors from organ donation after citizen's death is relatively high. It is effective to prevent the incidence of DDI by grading the risk of infection of donors and adopting rational preventive plan according to the score.
- Organ donation after citizen's death /
- Renal transplantation /
- Donor-derived infection /
- Pathogenic bacteria /
- Airway secretion /
- Gram-negative bacterium /
- Gram-positive bacterium

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图 1 供者感染病原菌来源分布

Figure 1. Source distribution of pathogenicbacteria in infected donors

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图 2 供者气道分泌物培养阳性菌株分布

Figure 2. Distribution of positive bacteria strains cultured in airway secretions of donors

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图 3 供者中段尿培养阳性菌株分布

Figure 3. Distribution of positive bacteria strains cultured in midstream urine of donors

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图 4 供者血培养阳性菌株分布

Figure 4. Distribution of positive bacteria strains cultured in blood of donors

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图 5 供肾灌洗液培养阳性菌株分布

Figure 5. Distribution of positive bacteria strains cultured in donor kidney lavage solution

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表 1 供者感染风险评分标准

Table 1. Scoring criteria of donor infection risk

分类	评分
ICU住院时间（d）
< 3	0
3~7	1
> 7	2
腹部外伤情况
无腹部外伤	0
腹部闭合性损伤	1
腹部开放性损伤	2
体液培养情况
体液培养（-）	0
痰培养（+）	1
中段尿培养（+）	2
供肾灌洗液/血培养（+）	3

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表 2 供者来源性感染受者病原菌分布情况

Table 2. Distribution of pathogenic bacteria from recipients with donor-derived infection

例序	性别	年龄（岁）	预防方案	痰培养	中段尿	血培养	肾周引流液	住院时间（d）
受者1	男	48	三联预防	铜绿假单胞菌	-	CRE（+）和ESBL（+）肺炎克雷伯菌	CRE（+）肺炎克雷伯菌	29
受者2	女	30	三联预防	-	-	CRE（+）和ESBL（+）肺炎克雷伯菌	CRE（+）肺炎克雷伯菌	82
受者3	男	42	三联预防	-	-	-	-	14
受者4	男	34	三联预防	铜绿假单胞菌	热带假丝酵母菌	-	-	20
受者1、2的供肾均来自供者1，受者3、4的供肾均来自供者2

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