公民逝世后器官捐献供者感染流行病学分布及主要病原菌耐药性分析

范鹏飞; 王清平; 王洪海; 张玮晔

doi:10.3969/j.issn.1674-7445.2022.02.011

公民逝世后器官捐献供者感染流行病学分布及主要病原菌耐药性分析

doi: 10.3969/j.issn.1674-7445.2022.02.011

300192 天津市第一中心医院重症监护二科

基金项目:

天津市卫生健康委员会科技项目 KJ20014

详细信息

作者简介:

通讯作者:
张玮晔，男，1975年生，硕士，副主任医师，研究方向为器官移植与器官捐献，Email：zwy7795@vip.sina.com

中图分类号: R617, R619
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出版历程
- 收稿日期: 2021-11-09
- 网络出版日期: 2022-03-18
- 刊出日期: 2022-03-15

Epidemiological distribution of donor infection and drug resistance of main pathogens in organ donation after citizen's death

Second Department of Intensive Care, Tianjin First Central Hospital, Tianjin 300192, China

More Information

Corresponding author: Zhang Weiye, Email: zwy7795@vip.sina.com

摘要

摘要: 目的分析公民逝世后器官捐献供者感染病原菌的分布特点及对抗菌药物的耐药性。方法回顾性分析465例潜在公民逝世后器官捐献供者的临床资料。所有供者均行气道分泌物、尿液和血液培养。总结供者感染发生率、病原菌来源和构成比，并进行主要革兰阴性和阳性菌耐药性分析。结果 465例供者中330例存在感染，感染率为71.0%。供者阳性培养标本中，下呼吸道标本占63.8%(292/458)、血液标本占18.6%(85/458)、尿液标本占17.7%(81/458)。共分离512株病原菌，其中革兰阴性菌占75.0%(384/512)，革兰阳性菌占18.2%(93/512)，真菌占6.8%(35/512)。革兰阴性菌中占比前3位的是肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌。肺炎克雷伯菌对喹诺酮类、β-内酰胺酶抑制剂复方制剂(哌拉西林-他唑巴坦、头孢哌酮钠-舒巴坦钠)及碳青霉烯类抗生素敏感性较高，对头孢菌素的敏感性较差; 铜绿假单胞菌对抗假单胞菌β-内酰胺类、喹诺酮类及氨基苷类敏感性均较高; 鲍曼不动杆菌仅对多黏菌素、替加环素及阿米卡星敏感性较高，对其余各类抗生素普遍耐药。革兰阳性菌中未检出对万古霉素、利奈唑胺及替考拉宁耐药的菌株，分离最多的是金黄色葡萄球菌和凝固酶阴性葡萄球菌，对苯唑西林钠耐药率分别为36%和87%，对青霉素和红霉素普遍耐药; 屎肠球菌对喹诺酮类及红霉素的耐药率均达到90%及以上，对高浓度庆大霉素耐药率达55%。结论公民逝世后器官捐献供者感染率较高，感染部位以肺部为主。革兰阴性菌是最主要的分离菌株，部分菌株呈现多重耐药趋势。
- 公民逝世后器官捐献 /
- 供者来源性感染 /
- 病原菌 /
- 定植 /
- 耐药性 /
- 凝固酶阴性葡萄球菌 /
- 肺炎克雷伯菌 /
- 铜绿假单胞菌 /
- 鲍曼不动杆菌 /
- 金黄色葡萄球菌 /
- 屎肠球菌
Abstract: Objective To analyze the distribution characteristics and drug resistance of pathogens in infected donors from organ donation after citizen's death. Methods Clinical data of 465 potential donors from organ donation after citizen's death were retrospectively analyzed. The airway secretion, urine and blood samples of all donors were cultured. The infection rate of the donors, the source and composition ratio of pathogens were summarized. The drug resistance of main Gram-negative and Gram-positive pathogens was analyzed. Results Among 465 donors, 330 cases were infected and the infection rate was 71.0%. Among the positive culture samples of all donors, lower respiratory tract samples accounted for 63.8%(292/458), 18.6%(85/458) for blood samples and 17.7%(81/458) for urine samples. A total of 512 pathogens were isolated, including 75.0%(384/512) of Gram-negative pathogens, 18.2%(93/512) of Gram-positive pathogens followed by 6.8%(35/512) of fungi. Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii were the most common Gram-negative pathogens. Klebsiella pneumoniae was sensitive to quinolones, compound preparations containing β-lactamase inhibitor (piperacillin-tazobactam, cefoperazone sodium-sulbactam sodium) and carbapenem antibiotics, whereas less sensitive to cephalosporins. Pseudomonas aeruginosa was sensitive to β-lactams, quinolones and aminoglycosides. Acinetobacter baumannii was sensitive to polymyxin, tigecycline and amikacin, whereas resistant to the other antibiotics. No Gram-positive pathogens was resistant to vancomycin, linezolid and teicoplanin. Staphylococcus aureus and coagulase-negative staphylococci were the most commonly isolated Gram-positive pathogens, which yielded resistance rates of 36% and 87% to oxacillin sodium, and were generally resistant to penicillin and erythromycin. The resistance rate of Enterococcus faecalis to quinolones and erythromycin exceeded 90%, and 55% for high-concentration gentamicin. Conclusions The infection rate of organ donors from organ donation after citizen's death is relatively high, and the main infection site is lung. Gram-negative pathogens are the most commonly isolated strains, and certain strains tend to exhibit multiple drug resistance.
- Organ donation after citizen's death /
- Donor-derived infection /
- Pathogen /
- Colonization /
- Drug resistance /
- Coagulase-negative staphylococci /
- Klebsiella pneumoniae /
- Pseudomonas aeruginosa /
- Acinetobacter baumannii /
- Staphylococcus aureus /
- Enterococcus faecium

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图 1 下呼吸道标本培养阳性菌株分布

Figure 1. Distribution of positive strains cultured in lower respiratory tract samples

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图 2 中段尿标本培养阳性菌株分布

Figure 2. Distribution of positive strains cultured in midstream urine samples

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图 3 血标本培养阳性菌株分布

Figure 3. Distribution of positive strains cultured in blood samples

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表 1 主要革兰阴性菌对常用抗菌药物的耐药情况

Table 1. Resistance of major Gram-negative bacteria to commonly used antibiotics [n(%)]

抗菌药物	肺炎克雷伯菌(n=116)	铜绿假单胞菌(n=81)	鲍曼不动杆菌(n=77)
阿米卡星	19(16)	9(11)	8(10)
环丙沙星	-^①	21(26)	58(75)
美罗培南	-	20(25)	57(74)
米诺环素	-	-	17(22)
哌拉西林-他唑巴坦	21(18)	35(43)	57(74)
替加环素	2(2)	81(100)	2(3)
替卡西林钠-克拉维酸钾	-	46(57)	57(74)
头孢吡肟	46(40)	9(11)	46(60)
头孢哌酮钠-舒巴坦钠	22(19)	21(26)	42(55)
头孢他啶	42(36)	24(30)	57(74)
亚胺培南	9(8)	31(38)	54(70)
多黏菌素	-	4(5)	0
左氧氟沙星	26(22)	20(25)	48(62)
阿莫西林-克拉维酸钾	36(31)	-	-
厄他培南	10(9)	-	-
头孢呋辛钠	53(46)	-	-
头孢曲松钠	55(47)	-	-
注：①-为无数据。

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表 2 主要革兰阳性菌对常用抗菌药物的耐药情况

Table 2. Resistance of major Gram-positive bacteria to commonly used antibiotics [n(%)]

抗菌药物	金黄色葡萄球菌(n=36)	凝固酶阴性葡萄球菌(n=23)	屎肠球菌(n=20)
青霉素	32(89)	21(91)	-^①
苯唑西林钠	13(36)	20(87)	-
头孢洛林酯	3(8)	-	-
利福平	1(3)	1(4)	-
左氧氟沙星	6(17)	7(30)	19(95)
莫西沙星	5(14)	3(13)	18(90)
复方磺胺甲唑	8(22)	9(39)	-
克林霉素	12(33)	8(35)	-
达托霉素	0	0	-
红霉素	21(58)	17(74)	18(90)
利奈唑胺	0	0	0
万古霉素	0	0	0
替考拉宁	0	0	0
替加环素	0	0	0
氨苄西林	-	-	18(90)
庆大霉素(高浓度)	-	-	11(55)
注：①-为无数据。

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