Kim Y J, Kim S I, Jun Y H, Choi J Y, Yoon S K, You Y-K, Kim D-G
Division of Infectious Disease, Department of Internal Medicine, Catholic University of Korea, Seoul, Korea.
Division of Infectious Disease, Department of Internal Medicine, Catholic University of Korea, Seoul, Korea.
Transplant Proc. 2014 Apr;46(3):828-31. doi: 10.1016/j.transproceed.2013.11.030.
Routine microbiologic surveillance is a method of infection control, but its clinical significance in transplant recipients is not known. We analyzed microbiologic data to evaluate the influence of cultured microorganisms between the point of surveillance and infectious episodes in liver transplant recipients.
We performed surveillance culture for sputum and peritoneal fluid in liver transplant recipients from January 2009 to December 2011, at the time of transplantation (T1), 5 days (T2), and 10 days (T3) postoperatively.
Of the 179 recipients, 32.9% had a positive sputum culture result and 37.4% had a positive peritoneal culture result during surveillance. In the culture surveillance of sputum, 37 organisms were isolated from 35 recipients at T1, and the most common organism was Staphylococcus aureus (n = 13). At T2, 45 organisms were isolated from 39 recipients, including Klebsiella pneumoniae (n = 10), S aureus (n = 8), and Acinetobacter baumannii (n = 6). At T3, 18 organisms were isolated from 15 patients, including Stenotrophomonas maltophilia (n = 5) and K pneumonia (n = 4). In the peritoneal fluid, 11 organisms were isolated from 10 recipients at T1, including Pseudomonas aeruginosa (n = 2) and Enterococcus species (n = 2). At T2, 39 organisms were isolated from 36 recipients, including coagulase-negative Staphylococcus species (CNS; n = 8) and Enterococcus species (n = 7). At T3, 54 organisms were isolated from 51 recipients, including CNS (n = 17) and Candida species (n = 8). Among the 59 patients with positive culture results for sputum surveillance, 16.9% developed pneumonia caused by the same organisms. Among the 67 patients with positive peritoneal fluid culture, 16.4% developed an intra-abdominal infection caused by the same organisms cultured. The recipients with positive surveillance culture had a higher risk of pneumonia (20.3% [12/59] vs 1.6% [2/120]; P < .001) and intra-abdominal infection (31.3% [21/67] vs 18.7% [21/112]; P = .05).
Periodic microbiologic surveillance may be useful in the prediction of post-transplantation pneumonia and intra-abdominal infection and could offer a potential target for empirical antimicrobial therapy in cases of infection.
常规微生物学监测是一种感染控制方法，但其在移植受者中的临床意义尚不清楚。我们分析了微生物学数据，以评估肝移植受者监测点与感染发作之间培养出的微生物的影响。
我们对2009年1月至2011年12月期间接受肝移植的患者在移植时（T1）、术后5天（T2）和10天（T3）进行痰液和腹腔液的监测培养。
179名受者中，监测期间32.9%的患者痰液培养结果为阳性，37.4%的患者腹腔培养结果为阳性。在痰液培养监测中，T1时从35名受者中分离出37种微生物，最常见的微生物是金黄色葡萄球菌（n = 13）。T2时，从39名受者中分离出45种微生物，包括肺炎克雷伯菌（n = 10）、金黄色葡萄球菌（n = 8）和鲍曼不动杆菌（n = 6）。T3时，从15名患者中分离出18种微生物，包括嗜麦芽窄食单胞菌（n = 5）和肺炎克雷伯菌（n = 4）。在腹腔液中，T1时从10名受者中分离出11种微生物，包括铜绿假单胞菌（n = 2）和肠球菌属（n = 2）。T2时，从36名受者中分离出39种微生物，包括凝固酶阴性葡萄球菌属（CNS；n = 8）和肠球菌属（n = 7）。T3时，从51名受者中分离出54种微生物，包括CNS（n = 17）和念珠菌属（n = 8）。在痰液监测培养结果为阳性的59名患者中，16.9%发生了由相同微生物引起的肺炎。在腹腔液培养阳性的67名患者中，16.4%发生了由培养出的相同微生物引起的腹腔内感染。监测培养结果为阳性的受者发生肺炎的风险更高（20.3% [12/59] 对1.6% [2/120]；P <.001）和腹腔内感染的风险更高（31.3% [21/67] 对18.7% [21/112]；P =.05）。
定期微生物学监测可能有助于预测移植后肺炎和腹腔内感染，并可为感染病例的经验性抗菌治疗提供潜在靶点。
