可能与保存液相关的供体来源的碳青霉烯类耐药肺炎克雷伯菌感染对肾移植受者的影响。
Effects of preservative fluid associated possible donor-derived carbapenem-resistant Klebsiella Pneumoniae infection on kidney transplantation recipients.
机构信息
Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China.
Institute of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China.
出版信息
BMC Nephrol. 2022 Mar 14;23(1):101. doi: 10.1186/s12882-022-02733-7.
BACKGROUND
Infections remain a major cause of morbidity and mortality in kidney transplant (KT) recipients. This study aimed to investigate the preservation fluid (PF) samples from deceased donors and report the impacts of possible donor-derived carbapenem-resistant Klebsiella pneumoniae (pdd-CRKP) infections on KT recipients.
METHODS
A retrospective study was performed that included all recipients who received kidney transplantation from deceased donors in our hospital between December 2018 and December 2020. A total of 212 patients received kidney transplantation from deceased donors, a total of 206 PF samples were collected, and 20 recipients had a CRKP-positive culture. Both donors and recipients with CRKP-positive PF cultures were divided into two groups, and continuous variables between the two groups were compared using independent-sample t tests and Mann-Whitney tests. Categorical variables were compared using the chi-square test or Fisher's exact test. The significance level of p values was set at 0.05.
RESULTS
A total of 337 recipients underwent kidney transplantation, including 212 recipients of organs from deceased donors and 110 corresponding deceased donors. A total of 206 PF samples were collected, and 20 recipients had CRKP-positive PF cultures. The donors' length of ICU stay was a potential risk factor for CRKP positivity in the PF culture (P < 0.05). Fifteen recipients were infected with pdd-CRKP, and the incidence of pdd-CRKP infection was 7.3% (15/206). The use of antibiotics, including ceftazidime-avibactam (CAZ-AVI), was a potential protective factor against death and graft loss in recipients with a CRKP-positive PF culture (P < 0.05).
CONCLUSIONS
This study shows that the incidence of pdd-CRKP is high in our centre, recipients with pdd-CRKP infection can still achieve a good prognosis with the use of antimicrobial agents including CAZ-AVI.
背景
感染仍然是肾移植（KT）受者发病率和死亡率的主要原因。本研究旨在研究来自已故供者的保存液（PF）样本，并报告可能来源于供者的碳青霉烯类耐药肺炎克雷伯菌（pdd-CRKP）感染对 KT 受者的影响。
方法
进行了一项回顾性研究，纳入 2018 年 12 月至 2020 年 12 月期间在我院接受已故供者肾移植的所有受者。共 212 例患者接受了已故供者的肾移植，共采集了 206 份 PF 样本，20 例受者的 CRKP 培养阳性。将 CRKP-PF 培养阳性的供者和受者分为两组，两组间连续变量采用独立样本 t 检验和 Mann-Whitney 检验进行比较，分类变量采用卡方检验或 Fisher 确切概率法进行比较。p 值的显著性水平设为 0.05。
结果
共 337 例患者接受了肾移植，其中 212 例患者接受了已故供者的器官，110 例相应的已故供者。共采集了 206 份 PF 样本，20 例受者的 CRKP-PF 培养阳性。供者 ICU 住院时间是 CRKP-PF 培养阳性的潜在危险因素（P<0.05）。15 例受者感染了 pdd-CRKP，pdd-CRKP 感染的发生率为 7.3%（15/206）。在 CRKP-PF 培养阳性的受者中，使用抗生素，包括头孢他啶-阿维巴坦（CAZ-AVI），是死亡和移植物丢失的潜在保护因素（P<0.05）。
结论
本研究表明，本中心 pdd-CRKP 的发生率较高，使用包括 CAZ-AVI 在内的抗菌药物，pdd-CRKP 感染的受者仍可获得良好的预后。
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