器官保存液培养阳性率、病原菌分布及临床意义研究

Positive rate, pathogen distribution and clinical significance of organ pre-servation solution culture

摘要:

目的 了解器官保存液（PS）微生物培养结果与受者移植后感染情况。 方法 回顾性收集2016年6月—2020年12月上海某三甲医院485例器官移植患者器官PS微生物培养结果，根据器官PS培养结果将受者分为阳性组和阴性组，阳性组依据不同菌株进一步分组，分析不同组患者移植后3个月内的感染情况。 结果 485例器官移植患者中，221例PS培养阳性，阳性率为45.57%，其中单一菌种142例（64.25%），2种菌54例（24.43%），≥3种菌25例（11.31%）。共分离病原菌327株，居前3位的是凝固酶阴性葡萄球菌（67株，20.49%）、肺炎克雷伯菌（37株，11.31%）和大肠埃希菌（27株，8.26%）。分离出常见多重耐药菌47株（14.37%），其中耐碳青霉烯类肺炎克雷伯菌（CRKP）20株（42.55%），耐碳青霉烯类鲍曼不动杆菌18株（38.29%）。阳性组患者移植后感染率（12.22%，27/221）数值高于阴性组（6.82%，18/264），但差异无统计学意义（P=0.243）；≥3种菌组患者移植后感染率为32.00%（8/25），高于单一菌组的9.15%（13/142）（P=0.004）；CRKP、白念珠菌阳性组患者移植后感染率分别为45.00%（9/20）、21.74%（5/23），均高于其他病原菌组的8.20%（15/183）（P值分别为 < 0.001、0.034）。 结论 常规监测器官PS培养结果对移植后感染防控具有指导意义，若PS培养CRKP、酵母菌或念珠菌阳性，建议立即进行相应抗感染的治疗。

Abstract:

Objective To understand the microbial culture results of organ preservation solution (PS) and post-transplant infection of recipients. Methods Microbial culture results of organ PS of 485 organ transplant patients in a tertiary hospital in Shanghai from June 2016 to December 2020 were collected retrospectively, according to organ PS culture results, patients were divided into positive group and negative group, positive group were subdivided into different groups according to the distribution of pathogens, infection of different groups within 3 months after transplant was statistically analyzed. Results Among 485 organ transplant patients, 221 cases (45.57%) were PS culture positive, 142 (64.25%) of whom were isolated single kind of pathogen, 54 (24.43%) were isolated two kinds of pathogens, and 25 (11.31%) were isolated ≥ three kinds of pathogens. A total of 327 strains of pathogens were isolated, the top three were coagulase negative staphylococcus (n=67, 20.49%), Klebsiella pneumoniae (n=37, 11.31%) and Escherichia coli (n=27, 8.26%). A total of 47 strains (14.37%) of multidrug-resistant organisms were isolated, including 20 strains (42.55%) of carbapenem-resistant Klebsiella pneumoniae (CRKP) and 18 strains (38.29%) of carbapenem-resistant Acinetobacter baumannii. Infection rate after transplant in positive group was higher than that in negative group (12.22%[27/221] vs 6.82%[18/264]), but difference was not statistically significant (P=0.243); infection rate after transplant in patients with ≥ 3 pathogen group was 32.00% (8/25), which was higher than 9.15% (13/142) in single pathogen group (P=0.004); infection rates of CRKP and Candida albicans positive groups were 45.00% (9/20) and 21.74% (5/23) respectively, which were both higher than 8.20% (15/183) of other pathogen groups (P < 0.001 and P < 0.034, respectively). Conclusion Routine monitoring on organ PS culture results can guide the prevention and control of infection after transplant, if PS culture is positive for CRKP, yeast or Candida, it is recommended to carry out corresponding anti-infection treatment immediately.