肝移植术后重症监护病房细菌感染的临床研究

目的分析肝移植术后重症监护病房(ICU)细菌感染的流行病学资料及抗菌药物敏感性,为临床有效预防和控制感染,减少耐药菌株提供依据。方法回顾性分析2000年11月至2004年6月我院肝移植术后ICU患者病原学资料及其对抗菌药物的敏感性。结果肝移植ICU细菌感染率高,病原菌多为多重耐药菌,其中革兰阴性菌(G-菌)占47.2%,革兰阳性菌(G+菌)占33.6%,真菌占19.2%。G-菌中以产酸克雷伯菌、不动杆菌、弗氏柠檬酸杆菌以及大肠埃希氏菌为主,对亚胺培南、左旋氧氟沙星最为敏感;G+菌以葡萄球菌属和肠球菌属为主,尤其是肠球菌属明显增多,对万古霉素、丁胺卡那霉素最为敏感。结论加强肝移植术后ICU的细菌分离及耐药性监测非常重要。依据病原学及抗菌药物敏感性资料合理选择抗菌药物控制感染,有助于减少新的耐药菌株的出现。

The clinical study of bacterial infection in ICU after liver transplantation

Objective To analyze the prevalence of bacterial infection and the drug sensitivity of bacteria in intensive care unit(ICU) after liver transplantation(LT),so as to provide the reference to the effective clinical prevention and control of bacterial infection and drug resistant strain.Methods The distribution of bacteria and their resistance to antibiotics in the ICU of our liver transplantation center from Nov.2000 to June 2004 were retrospectively analyzed.Results The bacterial infection rate in the ICU after LT was high.Most pathogens showed significant resistance to many antibiotics.The Gram-negative bacillus were 47.2%,among which Klebsiella oxytoca,Acinetobacter, Citrobacter freundii and Escherichia cole were major ones,especially sensitive to Imipenem and L-Ofloxacin.Gram-positive cocci accounted for 33.6%,among which Staphylococcus and Enterococcus were the most predominant ones,especially the latter with obviously high detection rate,mostly sensitive to Vancomycin,and Amikacim.And fungi accounted for 19.2%.Conclusion It is very important to monitor the distribution of bacteria and their resistance to antibiotics in ICU after liver transplantation.Selecting effective antibiotics referring to the etiologic data and resistance of bacteria can help to prevent the drug resistant strain.