作　　者： ; ; ; ; ; ;

机构地区： 中山大学附属第三医院

出　　处： 《中华肝脏外科手术学电子杂志》 2019年第6期502-506,共5页

摘　　要： 目的探讨肝移植受者术后肺炎克雷伯菌(KP)感染的临床特点及病原学特征。方法回顾性分析2015年1月至2018年12月中山大学附属第三医院岭南医院诊治的54例肝移植术后KP感染患者临床资料。其中男48例,女6例;年龄7个月~75岁,中位年龄54岁。分析KP感染发生、分布及耐药性。PCR检测2018年33株耐碳青霉烯肺炎克雷伯菌(CRKP)携带的常见碳青霉烯酶基因(blaIMP、blaKPC等)和β-内酰胺酶基因(blaSHV)情况。结果同期共完成699例肝移植,KP感染率7.7%(54/699),其中CRKP感染率5.2%(36/699)。KP和CRKP感染率逐年增加,KP感染率2018年达高峰(9.7%),CRKP感染率2017年达高峰(7.7%)。KP和CRKP的感染时间集中在术后30 d内,占比分别为80%及81%。78株KP主要来源于呼吸道,其次分别是腹腔及血液。KP的多部位检出率逐年上升。药物敏感分析显示KP对于青霉素类、头孢菌素类、碳青霉烯类及喹诺酮类药物耐药率逐年上升,在2017年达高峰;对于氨基糖苷类和氨曲南,2017年耐药率达最高;对于复方新诺明和四环素,2016年的耐药率最高。耐药基因检测显示33株CRKP中有16株携带blaKPC基因,3株CRKP携带blaIMP基因。结论肝移植受者术后KP感染以呼吸道为主,早期流行,多部位感染呈增长趋势,CRKP比例有所增加,耐药机制主要以产碳青霉烯酶为主,临床应加强早期综合防治,合理用药。 Objective To investigate the clinical and etiological characteristics of Klebsiella pneumoniae(KP)infection in the recipients after liver transplantation.Methods Clinical data of 54 patients infected with KP after liver transplantation in Lingnan Hospital,the Third Affiliated Hospital of Sun Yat-sen University from January 2015 to December 2018 were retrospectively analyzed.Among them,48 patients were male and 6 female,aged from 7 months to 75 years with a median age of 54 years.The incidence,distribution and drug resistance of KP infection were analyzed.The expression levels of common carbapenemase genes(blaIMP,blaKPC,etc.)andβ-lactamase gene(blaSHV)carried by 33 strains of carbapenem-resistant Klebsiella pneumoniae(CRKP)isolated in 2018 were quantitatively measured by PCR.Results A total of 699 cases of liver transplantation were performed in the same period.The KP infection rate was 7.7%(54/699),of which CRKP infection rate was 5.2%(36/699).The KP and CRKP infection rates increased year by year.The KP infection rate reached the peak at 9.7%in 2018,and the CRKP infection rate peaked at 7.7%in 2017.Approximately 80%and 81%of KP and CRKP infection occurred within postoperative 30 d.78 KP strains were mainly derived from respiratory tract,followed by abdominal cavity and blood.The detection rate of KP in multiple sites increased year by year.Drug sensitivity analysis demonstrated that the drug resistance rate of KP to penicillins,cephalosporins,carbapenems and quinolones elevated year by year,reaching the peak in 2017.The drug resistance rate towards aminoglycosides and aztreonam was the highest in 2017,and the drug resistance rate to compound sulfamethoxazole and tetracycline reached the peak in 2016.Drug resistance gene detection revealed that 16 of 33 CRKP strains carried blaKPC gene and 3 CRKP strains carried blaIMP gene.Conclusions KP infection primarily occurs in the respiratory tract of the recipients undergoing liver transplantation,which is prevalent in the early stage with an increasing tendency of mult

关 键 词： 肝移植 感染 克雷伯菌 肺炎 碳青霉烯酶

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