日本中心活体供肝移植后耐甲氧西林金黄色葡萄球菌感染的结局。
The outcomes of methicillin-resistant Staphylococcus aureus infection after living donor liver transplantation in a Japanese center.
机构信息
Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
出版信息
J Hepatobiliary Pancreat Sci. 2010 Nov;17(6):839-43. doi: 10.1007/s00534-010-0273-5. Epub 2010 Apr 8.
OBJECTIVE
The objective of this study is to present results from our review of methicillin-resistant Staphylococcus aureus (MRSA) infection in living-donor liver transplant (LDLT) recipients.
METHODS
Seventy patients with primary LDLT between August 1997 and May 2007 were retrospectively reviewed.
RESULTS
Overall, 9 patients (12.9%) encountered various kinds of MRSA infection after transplantation [peritonitis (6), bacteremia (6), pneumonia (3), wound infection (3), cholangitis (1)]; 4 of these 9 patients died. Of these 4 expired patients, 3 were highly urgent cases with very poor pretransplant status under ventilator support. In one patient, linezolid was effective after teicoplanin failure for severe systemic MRSA infections (bacteremia, peritonitis, cholangitis, pneumonia, and enteritis). Of the 4 patients in whom MRSA was isolated only in a nasal swab before transplantation, none developed MRSA infection after transplantation with a 3-day course of mupirocin prophylaxis.
CONCLUSIONS
MRSA infection was a contributing factor in death after transplantation in cases with poor pretransplant status. Linezolid was effective even for treating systemic MRSA infection after LDLT. A short course of mupirocin prophylaxis seemed to be effective and did not have any adverse effects.
目的
本研究旨在介绍我们对活体肝移植（LDLT）受者耐甲氧西林金黄色葡萄球菌（MRSA）感染的回顾结果。
方法
回顾性分析 1997 年 8 月至 2007 年 5 月间 70 例原发性 LDLT 患者的资料。
结果
共有 9 例（12.9%）患者在移植后发生各种类型的 MRSA 感染[腹膜炎（6 例）、菌血症（6 例）、肺炎（3 例）、伤口感染（3 例）、胆管炎（1 例)]；其中 4 例死亡。在这 4 例死亡患者中，有 3 例为超高紧急情况，移植前在呼吸机支持下状况极差。在 1 例患者中，替考拉宁治疗严重全身 MRSA 感染（菌血症、腹膜炎、胆管炎、肺炎和肠炎）失败后，利奈唑胺有效。在 4 例仅在移植前鼻拭子中分离出 MRSA 的患者中，预防性应用 3 天莫匹罗星后均未发生 MRSA 感染。
结论
在移植前状况较差的患者中，MRSA 感染是移植后死亡的一个促成因素。利奈唑胺即使在 LDLT 后治疗全身 MRSA 感染也有效。短疗程莫匹罗星预防似乎有效，且无任何不良反应。
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