鲍曼不动杆菌感染的肝移植受者中病原体的分布与耐药性
Distribution and resistance of pathogens in liver transplant recipients with Acinetobacter baumannii infection.
作者信息
Gao Fei, Ye Qifa, Wan Qiquan, Liu Shan, Zhou Jiandang
机构信息
Infectious Disease Department of Henan Province People's Hospital, Zhengzhou, People's Republic of China.
Department of Transplant Surgery, Third Xiangya Hospital, Central South University, Changsha, People's Republic of China ; Department of Transplant Surgery, Zhongnan Hospital, Wuhan University, Wuhan, People's Republic of China.
出版信息
Ther Clin Risk Manag. 2015 Mar 26;11:501-5. doi: 10.2147/TCRM.S82251. eCollection 2015.
BACKGROUND
Drug-resistant Acinetobacter baumannii has become a major problem in liver transplant recipients. The aim of this study was to investigate the clinical presentation, distribution, and drug susceptibility characteristics in liver recipients with A. baumannii infection.
METHODS
We retrospectively investigated 17 liver recipients who developed A. baumannii infection between January 1, 2007 and December 31, 2014. The distribution of A. baumannii and drug susceptibility characteristics were reviewed.
RESULTS
Infectious complications due to A. baumannii appeared in 17 liver recipients, with a total of 24 episodes. Approximately 63% (15/24) of A. baumannii infections occurred within 2 weeks after transplantation. The most common source of infection was multiple culture-positive sites (35.3%, n=6), followed by the intra-abdominal/biliary tract (23.5%, n=4) and lung (23.5%, n=4). Eight patients (47.1%) had a body temperature of 38°C or higher at the onset of A. baumannii infection. Nine, seven, and 12 recipients had a serum creatinine level of >1.5 mg/dL, a white blood cell count of >15,000/mm(3), and a platelet count of <50,000/mm(3), respectively. There were five (29.4%) cases of septic shock and eight (47.1%) deaths. The rate of antibiotic resistance of A. baumannii to ten of 12 antibiotics investigated was more than 60%. Among the 24 infections caused by A. baumannii, 75% were carbapenem-resistant. The rods were relatively sensitive to tigecycline and cefoperazone-sulbactam.
CONCLUSION
The clinical manifestations of A. baumannii infection included a high body temperature, a decreased platelet count, an elevated white blood cell count, and onset in the early period after transplantation as well as high mortality. The antibiotic resistance rate of A. baumannii was extremely high. Prevention measures and combination antibiotic therapy are needed to improve the outcomes of liver recipients with A. baumannii infections.
背景
耐多药鲍曼不动杆菌已成为肝移植受者面临的一个主要问题。本研究旨在调查鲍曼不动杆菌感染的肝移植受者的临床表现、分布情况及药敏特征。
方法
我们回顾性调查了2007年1月1日至2014年12月31日期间发生鲍曼不动杆菌感染的17例肝移植受者。对鲍曼不动杆菌的分布及药敏特征进行了分析。
结果
17例肝移植受者出现了鲍曼不动杆菌引起的感染并发症，共24次发作。约63%（15/24）的鲍曼不动杆菌感染发生在移植后2周内。最常见的感染源是多个培养阳性部位（35.3%，n = 6），其次是腹腔/胆道（23.5%，n = 4）和肺部（23.5%，n = 4）。8例患者（47.1%）在鲍曼不动杆菌感染发作时体温达到38°C或更高。9例、7例和12例受者的血清肌酐水平分别>1.5 mg/dL、白细胞计数>15,000/mm³和血小板计数<50,000/mm³。有5例（29.4%）发生感染性休克，8例（47.1%）死亡。鲍曼不动杆菌对所调查的12种抗生素中的10种的耐药率超过60%。在24例由鲍曼不动杆菌引起的感染中，75%对碳青霉烯类耐药。这些杆菌对替加环素和头孢哌酮-舒巴坦相对敏感。
结论
鲍曼不动杆菌感染的临床表现包括高热、血小板计数降低、白细胞计数升高、移植后早期发病以及高死亡率。鲍曼不动杆菌的耐药率极高。需要采取预防措施和联合抗生素治疗以改善鲍曼不动杆菌感染的肝移植受者的预后。
Zotero 插件