Kawecki D, Pacholczyk M, Łagiewska B, Adadyński L, Lisik W, Sawicka-Grzelak A, Durlik M, Paczek L, Chmura A, Mlynarczyk G, Rowinski W, Luczak M
Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland.
Transplant Proc. 2011 Oct;43(8):3052-4. doi: 10.1016/j.transproceed.2011.09.003.
We performed an analysis of etiologic agents for urinary tract infections in the early posttransplant period after orthotopic liver transplantation (OLT) in adult recipients.
The study covered the first 4 weeks after OLT of 190 patients from September 2001 to the end of 2007. Immunosuppression consisted of steroids and tacrolimus. Antimicrobial prophylaxis was piperacillin/tazobactam, fluconazole, and SBD. Urine samples were cultured to identify microorganisms in accord with standard microbiological procedures and to test susceptibility using Clinical Laboratory and Standards Institute guidelines.
Urine specimens (n=539) examined from 185 recipients (97.4%) showed 210 microbial strains. The most common were Gram-negative (n=131; 62.4%) with predominance of Escherichia coli (28.2%), Enterobacter cloacae (19.1%), and Acinetobacter baumannii (11.4%). Extended-spectrum β- lactamases (ESBL(+)) strains were isolated in 38.5% of cases. Gram-positive bacteria comprised 28.6% (n=60): The most common strains were enterococci (85% including HLAR 80.4% and VRE 17.6%] and staphylococci 11.8% [MRSA/MRCNS; 100%]. There were 19 (9%) fungal strains.
In general, the identification in urine samples of multi-drug-resistant bacterial and fungal strains in patients after OLT such as ESBL(+) 38.5%; HLAR 80.4%; VRE 17.6%; and MRSA/MRCNS 100% requires better infection control.
我们对成年原位肝移植（OLT）受者移植后早期尿路感染的病原体进行了分析。
该研究涵盖了2001年9月至2007年底190例患者OLT后的前4周。免疫抑制方案包括使用类固醇和他克莫司。抗菌预防用药为哌拉西林/他唑巴坦、氟康唑和SBD。按照标准微生物学程序对尿液样本进行培养以鉴定微生物，并依据临床实验室标准协会指南检测药敏情况。
185例（97.4%）受者的539份尿液标本检测出210株微生物菌株。最常见的是革兰阴性菌（n = 131；62.4%），其中以大肠杆菌（28.2%）、阴沟肠杆菌（19.1%）和鲍曼不动杆菌（11.4%）为主。38.5%的病例分离出超广谱β-内酰胺酶（ESBL(+)）菌株。革兰阳性菌占28.6%（n = 60）：最常见的菌株是肠球菌（85%，包括高水平氨基糖苷类耐药肠球菌80.4%和耐万古霉素肠球菌17.6%）以及葡萄球菌11.8%（耐甲氧西林金黄色葡萄球菌/耐甲氧西林凝固酶阴性葡萄球菌；100%）。有19株（9%）真菌菌株。
总体而言，OLT术后患者尿液样本中检测出多种耐药细菌和真菌菌株，如ESBL(+) 38.5%；高水平氨基糖苷类耐药肠球菌80.4%；耐万古霉素肠球菌17.6%；以及耐甲氧西林金黄色葡萄球菌/耐甲氧西林凝固酶阴性葡萄球菌100%，这需要更好的感染控制措施。
