摘要
目的探讨肝移植术后血行感染中产超广谱β内酰胺酶(ESBL)的大肠埃希菌、肺炎克雷伯菌的流行病学、细菌学及临床结果。方法选择1998年1月至2009年12月12年间本院肝移植患者资料,对其移植术后血行感染中产ESBL大肠埃希菌、肺炎克雷伯菌的情况进行回顾性分析。结果 768例肝移植患者中,19(2.5%)例出现产ESBL革兰阴性杆菌血行感染,共分离到革兰阴性杆菌菌株共23株,其中大肠埃希菌、肺炎克雷伯菌最为常见,产气大肠杆菌、阴沟大肠杆菌、铜绿假单胞菌较少。产ESBL的大肠埃希菌、肺炎克雷伯菌对碳青霉烯类敏感率高达100%,但产ESBL大肠埃希菌对左旋氧氟沙星、头孢曲松、妥布霉素等多种抗生素出现耐药。产ESBL肺炎克雷伯菌则对头孢曲松出现完全耐药。肝移植术后产ESBL大肠埃希菌、肺炎克雷伯菌血行感染患者与非产ESBL大肠埃希菌、肺炎克雷伯菌血行感染患者之间的15d、30d、1年死亡率差异无统计学意义。结论肝移植术后血行感染中产ESBL大肠埃希菌、肺炎克雷伯菌对多种抗生素耐药,对碳青霉烯类敏感;产ESBL大肠埃希菌、肺炎克雷伯菌血行感染并未明显增加患者死亡率。
Objective To define the microbial epidemiology and outcome of Extended-spectrum β-1actamases （ESBLs）-producing Klebsiella spp. and Escherichia coli in bloodstream infections（BSI） after liver transplantation. Methods From January 1998 to December 2009, a retrospective analysis of ESBLs-producing Klebsiella spp. and Eseherichia coil were conducted. Results BSI occurred in 19 （2.5%） patients of the 768 patients, in which a total 23 gram-negative bacilli （GNB） were isolated. The most frequent pathogens were Escherichia coli and Klebsiella spp. enterobacter cloacae, pseudomonas aeruginosa, Enterobacter aerogenes were few. Carbapenems were the most consistently active against the Escherichia coli and Klebsiella spp which were resistant to ceftriaxone. No significance in 15-day, 30-day, 1-year mortality between ESBL-producing and non-ESBL-producing Klebsiella spp. and Escherichia coli. Conclusion ESBL-producing Klebsiella spp. and Escherichia coli after liver transplantion are resistant to agents but active to Carbapenems commonly, which can not increase 15-day, 30-day, 1-year mortality simuhneously.
出处
《中华普通外科学文献（电子版）》
2011年第5期46-49,共4页
Chinese Archives of General Surgery(Electronic Edition)
基金
卫生部部属(管)医院2010-2012年度临床学科重点项目(159号)
广东省科技计划(2010B031600205)
广东省医学科研基金(A2010158)
