在中国的一项回顾性队列研究中，探讨了死亡肾移植受者保存液中微生物污染的发生率、分布和临床相关性。
Incidence, distribution and clinical relevance of microbial contamination of preservation solution in deceased kidney transplant recipients: a retrospective cohort study from China.
机构信息
Kidney Disease Centre, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, China; Institute of Nephrology, Zhejiang University, Hangzhou, China; The Third Grade Laboratory under the National State, Administration of Traditional Chinese Medicine, Hangzhou, China.
Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
出版信息
Clin Microbiol Infect. 2019 May;25(5):595-600. doi: 10.1016/j.cmi.2018.12.040. Epub 2019 Jan 16.
OBJECTIVES
To determine whether microbial contamination of preservation solution (PS) in kidney transplantation is associated with donor-derived infections (DDIs).
METHODS
We retrospectively analysed data from 1077 deceased kidney transplant recipients of 560 donors. In all, 1002 PS samples were collected for microbiological assessment to establish the incidence and distribution of contamination. Comparisons between patients with contaminated PS and those with sterile PS were performed to assess the impact of microbial contaminations in perfusate on probable donor-derived infections (p-DDIs), and potential risk factors for p-DDIs were examined.
RESULTS
The contamination rate of PS was 77.8% (402/517). Bacterial species accounted for 85.6% (887/1036) of the total 1036 isolated microorganisms and 26.5% (275/1002) of the recipients' PS were contaminated by ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp.). Enterococcus predominated the microbiological pattern. The incidence of infection was significantly higher in patients with microbial contamination than in patients with sterile PS (13.8% (107/776) versus 7.1% (16/226), p 0.006). The prevalence of p-DDIs was significantly higher in patients with ESKAPE contamination than in patients with other bacterial contamination in PS (7.2% (18/251) versus 1.0% (4/405), p 0.000). Univariate analysis indicated that ESKAPE contamination increased the risk of p-DDIs (p 0.001, OR 3.610, 95% CI 1.678-7.764). Multivariate analysis determined ESKAPE contamination as the only independent risk factor associated with p-DDIs (OR 3.418, 95% CI 1.580-7.393).
CONCLUSIONS
The high rate of microbial contaminations in PS is unusual and probably due to poor surgical procedures. Patients whose PS are contaminated by ESKAPE pathogens could have a significantly increased risk of p-DDIs at early post-transplantation.
目的
确定肾移植中保存液（PS）的微生物污染是否与供体来源感染（DDI）有关。
方法
我们回顾性分析了 560 名供体的 1077 名已故肾移植受者的数据。共采集 1002 份 PS 样本进行微生物评估，以确定污染的发生率和分布。比较 PS 污染患者和无菌 PS 患者，评估灌注液中微生物污染对可能的供体来源感染（p-DDI）的影响，并检查 p-DDI 的潜在危险因素。
结果
PS 的污染率为 77.8%（402/517）。细菌种类占总分离微生物的 85.6%（887/1036），26.5%（275/1002）的受者 PS 被 ESKAPE 病原体（粪肠球菌、金黄色葡萄球菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌和肠杆菌属）污染。肠球菌是微生物模式的主要优势菌。微生物污染患者的感染发生率明显高于无菌 PS 患者（13.8%（107/776）比 7.1%（16/226），p=0.006）。ESKAPE 污染患者的 p-DDI 发生率明显高于 PS 中其他细菌污染患者（7.2%（18/251）比 1.0%（4/405），p=0.000）。单因素分析表明，ESKAPE 污染增加了 p-DDI 的风险（p=0.001，OR 3.610，95%CI 1.678-7.764）。多因素分析确定 ESKAPE 污染是与 p-DDI 相关的唯一独立危险因素（OR 3.418，95%CI 1.580-7.393）。
结论
PS 中微生物污染率很高，这很不寻常，可能是由于手术过程不佳所致。PS 被 ESKAPE 病原体污染的患者在移植后早期发生 p-DDI 的风险显著增加。
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