肝移植供体碳青霉烯类耐药菌杆菌的预防与治疗——单中心经验
Prevention and Treatment of Carbapenem-Resistant Organism Bacilli from Liver Transplantation Donors - Single Center Experience.
作者信息
He Li, Fu Zhi, Wang Menglong, Wang Xin, Wang Lu, Li Guangming, Lin Dongdong
机构信息
Department of Intensive Care Unit, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People's Republic of China.
Department of General Surgery Center, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People's Republic of China.
出版信息
Infect Drug Resist. 2022 Jan 6;15:47-52. doi: 10.2147/IDR.S346494. eCollection 2022.
OBJECTIVE
To evaluate and explore the effectiveness of the new prevention and control measures for the donor-derived infection (DDI) associated with CRO after liver transplantation.
METHODS
The data of 120 organ donors and recipients from January 2018 to May 2020 were retrospectively analyzed at The Liver Transplantation Center of Beijing Youan Hospital, Capital Medical University, to investigate the epidemiological status of CRO in donors. The cases were divided into two groups. The implemented group was treated according to the execution of a clustered CRO prevention and control measure based on active screening combined with early initiation of prophylactic/therapeutic administration of antibiotics. The effectiveness of the prevention and control measures was evaluated by comparing the length of postoperative ICU stay, total postoperative length of hospital stay, duration of ventilator use, duration of restricted antibiotics use, the incidence of DDI, incidence and composition distribution of DDI-related CRO, and incidence of severe DDI-relevant adverse events between the two groups.
RESULTS
There was a high detection rate of 39.32% (105 strains) of drug-resistant bacteria in the donors. Fifty-six strains of CRO were detected. Participants in group B, which implemented the new prevention and control measures, were transferred out of the ICU sooner (P = 0.023), used fewer restrictive antibiotics (P = 0.003), and were discharged more quickly (P = 0.013) than those in group A. Postoperative DDI incidences (P = 0.113) and severe DDI-related adverse events were not statistically different between the two groups (P = 0.062). CR-Kp-related DDI was less common in group B (P = 0.021).
CONCLUSION
The situation of donor-derived drug-resistant bacterial infections remains critical. The clustered prevention and control measures for CRO based on active screening combined with early initiation of prophylactic/therapeutic application of antibiotics would be beneficial.
目的
评估并探索肝移植后与耐碳青霉烯类肠杆菌科细菌（CRO）相关的供体源性感染（DDI）新防控措施的有效性。
方法
对首都医科大学附属北京佑安医院肝移植中心2018年1月至2020年5月期间120例器官供体和受体的数据进行回顾性分析，以调查供体中CRO的流行病学状况。将病例分为两组。实施组根据基于主动筛查并结合早期预防性/治疗性使用抗生素的CRO聚集防控措施进行治疗。通过比较两组术后重症监护病房（ICU）住院时间、术后总住院时间、呼吸机使用时间、限制使用抗生素时间、DDI发生率、DDI相关CRO的发生率和构成分布以及严重DDI相关不良事件的发生率，评估防控措施的有效性。
结果
供体中耐药菌的检出率高达39.32%（105株）。检测到56株CRO。实施新防控措施的B组参与者比A组更早转出ICU（P = 0.023），使用的限制抗生素更少（P = 0.003），出院更快（P = 0.013）。两组术后DDI发生率（P = 0.113）和严重DDI相关不良事件无统计学差异（P = 0.062）。B组中与肺炎克雷伯菌碳青霉烯酶（CR-Kp）相关的DDI较少见（P = 0.021）。
结论
供体源性耐药菌感染情况仍然严峻。基于主动筛查并结合早期预防性/治疗性应用抗生素的CRO聚集防控措施将是有益的。
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