Rubin R H, Wolfson J S, Cosimi A B, Tolkoff-Rubin N E
Am J Med. 1981 Feb;70(2):405-11. doi: 10.1016/0002-9343(81)90780-4.
The incidence of infection in the renal transplant patient is directly related to the net immunosuppressive effect achieved and the duration of time over which this therapy is administered. A second major factor in the causation of infections in this population is the nosocomial hazards to which these patients are exposed, ranging from invasive instrumentation to environmental contamination with Aspergillus species, Legionella pneumophila, Pseudomonas aeruginosa and other microbial pathogens. Careful surveillance is necessary to identify and eliminate such nosocomial sources of infection. The major types of infection observed can be categorized according to the time period post-transplant in which they occur: postsurgical bacterial infection in the first month after transplantation; opportunistic infection, with cytomegalovirus playing a major role, and transplant pyelonephritis in the period one to four months post-transplant; and a mixture of conventional and opportunistic infections in the last post-transplant period. Conventional infection in this late period occurs primarily in patients with good renal function who are receiving minimal immunosuppressive therapy; opportunistic infection occurs primarily in patients with poor renal function who are receiving higher levels of immunosuppression.
肾移植患者感染的发生率与所达到的净免疫抑制效果以及进行该治疗的持续时间直接相关。该人群感染发生的第二个主要因素是这些患者面临的医院感染风险，范围从侵入性操作到环境被曲霉菌、嗜肺军团菌、铜绿假单胞菌及其他微生物病原体污染。必须进行仔细监测以识别和消除此类医院感染源。观察到的主要感染类型可根据移植后发生的时间段进行分类：移植后第一个月的术后细菌感染；巨细胞病毒起主要作用的机会性感染以及移植后1至4个月期间的移植肾盂肾炎；以及移植后期传统感染和机会性感染的混合。后期的传统感染主要发生在肾功能良好且接受最小免疫抑制治疗的患者中；机会性感染主要发生在肾功能差且接受较高水平免疫抑制的患者中。
