肾移植受者术后感染临床分析

目的探究肾移植受者术后感染情况及其危险因素。 方法回顾性分析2018年1月1日至12月31日于首都医科大学附属北京友谊医院接受肾移植的94例受者临床资料。供肾均采用Lifeport行低温机械灌注,并向灌注液中加入头孢哌酮舒巴坦钠以预防供者来源感染。根据受者术后3个月内体液培养结果,将94例受者分为感染组和对照组。采用卡方检验比较感染组和对照组受者性别、灌注液培养阳性比例和移植肾功能延迟恢复(DGF)发生率。采用Wilcoxon符号秩和检验比较两组受者年龄、移植前血清肌酐水平和住院时间。将单因素分析中有统计学差异的变量纳入Logistic回归进行多因素分析。P<0.05为差异有统计学意义。 结果术后3个月内94例受者中41例受者血、尿、痰及引流液标本中培养出病原菌,感染率为43.6%(41/94),且感染多发生于术后1周至1个月内,占34.0%(32/94)。41例受者共发生58例次感染,病原菌多来源于泌尿系统感染,占51.7%(30/58),其次为手术部位和血液系统感染,分别占32.8%(19/58)和13.8%(8/58),呼吸道感染占比最低,为1.7%(1/58)。27例受者为单一病原菌感染,14例为2种及以上病原菌感染。41例受者共分离出66株病原菌,其中细菌占89.4%(59/66),真菌占10.6%(7/66)。截至2019年7月10日,94例受者均存活,所有感染经治疗后均好转,未出现严重感染性疾病或因感染发生移植物丢失。单因素分析结果表明,感染组与对照组年龄、性别、移植前血清肌酐水平及住院时间差异均无统计学意义(z＝－0.206、χ²＝0.628、z＝－0.599、z＝－0.031,P均>0.05);两组受者灌注液培养阳性比例及DGF发生率差异均有统计学意义(χ²＝0.031和0.274,P均<0.05)。Logistic回归多因素分析结果显示,灌注液培养阳性是引起肾移植术后感染的独立危险因素(P<0.05)。 结论肾移植受者术后感染发生率较高,感染部位主要为泌尿系统,灌注液培养阳性是肾移植术后感染独立危险因素。

Clinical analysis of postoperative infections in kidney transplant recipients

ObjectiveTo explore the infection status and risk factors after kidney transplantation. MethodsThe clinical data of 94 recipients who received kidney transplantation in Beijing Friendship Hospital, Capital Medical University from January 1 to December 31, 2018 were retrospectively analyzed. All the donor kidneys were preserved with Lifeport for low-temperature mechanical perfusion, and cefoperazone sulbactam sodium was added to the perfusion solution to prevent donor-derived infection. According to the results of body fluid culture within 3 months after transplantation, 94 recipients were divided into infection group and control group. Chi-square test was used to compare the sex of recipients, the ratio of positive perfusate culture and incidence of delayed graft function (DGF) in infected and control groups. Wilcoxon signed rank sum test was used to compare the age, preoperative serum creatinine and hospitalization time of the two groups. The variables with statistical difference in univariate analysis were included in Logistic regression for multivariate analysis. P<0.05 was considered statistically significant. ResultsPathological bacteria were cultured in blood, urine, sputum and drainage fluid specimens of 41 recipients within 3 months after transplantation, the infection rate was 43.6% (41/94), and infections mostly occurred during 1 week to 1 month after transplantation, accounting for 34.0% (32/94). A total of 58 infections occurred in 41 recipients. The pathogens were mostly from the urinary system, accounting for 51.7% (30/58), followed by surgical site infections and blood infections, accounting for 32.8% (19/58) and 13.8% (8/58), the lowest proportion of respiratory tract infections, accounting for 1.7% (1/58). 27 recipients were infected with a single pathogen, and 14 were infected with 2 or more pathogens. A total of 66 pathogenic bacteria were isolated from 41 recipients, of which bacteria accounted for 89.4% (59/66) and fungi accounted for 10.6% (7/66). As of July 10, 2019, 94 recipients have survived, all infections had improved after treatment, and no serious infectious diseases or graft loss due to infection had occurred. Univariate analysis showed that there was no statistically significant difference between the infected group and the control group in age, gender, pre-transplant serum creatinine and hospitalization time (z=-0.206, χ²=0.628, z=-0.599, z=-0.031, P all >0.05); the ratio of positive perfusate culture and the incidence of DGF between the two groups of recipients were statistically significant (χ²=0.031 and 0.274, P all <0.05). Logistic regression multivariate analysis showed that positive perfusate culture was an independent risk factor for infection after kidney transplantation (P<0.05). ConclusionsKidney transplant recipients have a higher incidence of postoperative infections, the main site of infection is the urinary system, and positive perfusate culture is an independent risk factors for infections after kidney transplantation.