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DCD时代肾移植术后耐碳青霉烯类肺炎克雷伯菌感染的治疗经验总结

刘炎忠 柏宏伟 钱叶勇 石炳毅 常京元 李超 李钢 解俊杰 余飞

刘炎忠, 柏宏伟, 钱叶勇, 等. DCD时代肾移植术后耐碳青霉烯类肺炎克雷伯菌感染的治疗经验总结[J]. 器官移植, 2020, 11(1): 76-81. doi: 10.3969/j.issn.1674-7445.2020.01.012
引用本文: 刘炎忠, 柏宏伟, 钱叶勇, 等. DCD时代肾移植术后耐碳青霉烯类肺炎克雷伯菌感染的治疗经验总结[J]. 器官移植, 2020, 11(1): 76-81. doi: 10.3969/j.issn.1674-7445.2020.01.012
Liu Yanzhong, Bai Hongwei, Qian Yeyong, et al. Summary of treatment experience of carbapenem-resistant Klebsiella pneumoniae infection after renal transplantation in DCD era[J]. ORGAN TRANSPLANTATION, 2020, 11(1): 76-81. doi: 10.3969/j.issn.1674-7445.2020.01.012
Citation: Liu Yanzhong, Bai Hongwei, Qian Yeyong, et al. Summary of treatment experience of carbapenem-resistant Klebsiella pneumoniae infection after renal transplantation in DCD era[J]. ORGAN TRANSPLANTATION, 2020, 11(1): 76-81. doi: 10.3969/j.issn.1674-7445.2020.01.012

DCD时代肾移植术后耐碳青霉烯类肺炎克雷伯菌感染的治疗经验总结

doi: 10.3969/j.issn.1674-7445.2020.01.012
基金项目: 

首都临床特色应用研究与成果推广 Z171100001017184

详细信息
    作者简介:

    刘炎忠,男,1988年生,硕士,主治医师,研究方向为肾移植的基础及临床研究,Email:15001168010@163.com

    通讯作者:

    柏宏伟,男,1973年生,主任医师,研究方向为肾脏移植、免疫抑制剂调整以及泌尿外科常见疾病的诊治,Email:baihongwei99@163.com

  • 中图分类号: R617, R619.3

Summary of treatment experience of carbapenem-resistant Klebsiella pneumoniae infection after renal transplantation in DCD era

More Information
  • 摘要:   目的  总结心脏死亡器官捐献(DCD)时代肾移植术后耐碳青霉烯类肺炎克雷伯菌(CRKP)感染的临床治疗经验。  方法  回顾性分析2015年1月至2019年1月行DCD供肾移植术后CRKP感染的17例受者和10例供者临床资料。供、受者均行细菌培养和药敏试验; 记录CRKP感染受者的临床表现、治疗及转归情况。  结果  7例供者感染CRKP,对其预处理后,2例供者CRKP转阴,5例供者CRKP未转阴。所有供肾均接受替加环素+美罗培南+伏立康唑灌洗预防感染。17例CRKP感染的受者中,包括11例血培养阳性、10例尿培养阳性、3例痰培养阳性、3例切口分泌物阳性、3例腹膜后引流液阳性; 其临床表现包括发热8例、移植肾动脉破裂出血7例或移植肾动脉内血栓形成1例、膀胱刺激征3例、咳砖红色胶冻样痰1例。接受替加环素+美罗培南治疗5例,移植肾丢失1例,受者死亡4例; 接受头孢他啶-阿维巴坦+美罗培南治疗12例,移植肾丢失3例,受者死亡1例。  结论  CRKP感染供者并非肾移植的绝对禁忌证,提前处理供者感染,受者术后早期给予足量敏感抗生素可以治愈感染,改善肾移植受者预后。

     

  • 表  1  CRKP感染供者细菌培养结果、预处理情况

    Table  1.   Bacterial culture result and pretreatment situation of CRKP infected donors

    供者例序 培养标本 供者预处理措施 供者预处理结果
    尿 痰液 供肾灌洗液
    1 (-) (+) (-) (+) 替加环素+美罗培南 未转阴
    2 (-) (-) (+) (-) 误以为假阳性
    3 (-) (-) (-) (+) 误以为真阴性
    4 (-) (+) (-) (-) 头孢他啶-阿维巴坦+美罗培南 转阴
    5 (+) (+) (-) (-) 头孢他啶-阿维巴坦+美罗培南 转阴
    6 (-) (+) (-) (+) 头孢他啶-阿维巴坦+美罗培南 未转阴
    7 (-) (+) (-) (+) 头孢他啶-阿维巴坦+美罗培南 未转阴
    下载: 导出CSV

    表  2  CRKP感染受者的临床表现、治疗及转归情况

    Table  2.   Clinical manifestation, treatment and outcome of CRKP infected recipients

    供者例序 供者感染 受者例序 术后感染时间(d) 临床症状 术后并发症 治疗 存活情况
    1 (+) 1 14 发热、血栓、出血 替加环素+美罗培南 存活 死亡
    2 14 发热、出血 切口及肺部感染 替加环素+美罗培南 存活 死亡
    2 (+) 3 9 出血 DGF 头孢他啶-阿维巴坦+美罗培南 切肾 存活
    4 7 出血 肺部感染、CRKP复发 头孢他啶-阿维巴坦+美罗培南 切肾 存活
    3 (+) 5 14 出血 DGF、胰腺炎 替加环素+美罗培南+磷霉素 存活 死亡
    6 14 发热、膀胱刺激征、出血 切口感染 替加环素+美罗培南 切肾 存活
    4 (+) 7 14 发热、出血 头孢他啶-阿维巴坦+美罗培南 切肾 存活
    8 14 头孢他啶-阿维巴坦+美罗培南 存活 存活
    5 (+) 9 30 发热、膀胱刺激征 头孢他啶-阿维巴坦+美罗培南 存活 存活
    10 头孢他啶-阿维巴坦+美罗培南 存活 存活
    6 (+) 11 头孢他啶-阿维巴坦+美罗培南 存活 存活
    12 头孢他啶-阿维巴坦+美罗培南 存活 存活
    7 (+) 13 头孢他啶-阿维巴坦+美罗培南 存活 存活
    14 头孢他啶-阿维巴坦+美罗培南 存活 存活
    8 (-) 15 91 发热、咳痰 呼吸衰竭 替加环素+美罗培南 存活 死亡
    9 (-) 16 262 发热、膀胱刺激征 CRKP复发、排斥反应 头孢他啶-阿维巴坦+美罗培南 存活 存活
    10 (-) 17 186 发热、膀胱刺激征 肺部感染、精神病 头孢他啶-阿维巴坦+美罗培南 存活 死亡
    注:①DGF为移植物功能延迟恢复。
    下载: 导出CSV
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  • 收稿日期:  2019-10-17
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2020-01-15

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