作　　者： ; ; ; ; ; ; ; ;

机构地区： 广州医科大学

出　　处： 《器官移植》 2019年第6期713-718,共6页

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。 Objective To investigate the distribution characteristics of pathogenic abcteria in infectious donors from organ donation after citizen's death and preventive stratgeies for renal transplant recipients.Methods Clinical data of 412 donors and 803 recipients from organ donation after citzien's death were retrospectively analyzed.All donors underwent culture of airway secretions,urine,blood and renalla vage fluid.The incidence rate of infection,distribution an d 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 intensivcea re unit(ICU)stay for donors,the situation of abdomina l trauma and the results of body fluid culture,e tc.According to the score,the recipients received different inefction 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,a imnly 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 adteh is relatively high.It is effective to prevent the inciden c of DDI by grading the risk of infection of donors and adopting rational preventive plan according to the score.

关 键 词： 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

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