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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2016, Vol. 05 ›› Issue (03) : 158 -162. doi: 10.3877/cma.j.issn.2095-3232.2016.03.008

所属专题： 文献；

临床研究

肝移植患者术后多重耐药鲍曼不动杆菌感染影响因素
浦燕萍1, 顾燕1, 杨富2, 王春光1, 彭文1, 方芳2, 钟林1,†()   
  1. 1. 200080　上海交通大学附属第一人民医院肝移植中心
    2. 200080　上海交通大学附属第一人民医院护理部
  • 收稿日期:2016-03-15 出版日期:2016-06-10
  • 通信作者: 钟林

Influencing factors of multi-drug resistant Acinetobacter baumannii infection in patients after liver transplantation

Yanping Pu1, Yan Gu1, Fu Yang2, Chunguang Wang1, Wen Peng1, Fang Fang2, Lin Zhong1,†()   

  1. 1. Liver Transplantation Center, Shanghai General Hospital, Shanghai 200080, China
    2. Department of Nursing, Shanghai General Hospital, Shanghai 200080, China
  • Received:2016-03-15 Published:2016-06-10
  • Corresponding author: Lin Zhong
  • About author:
    Corresponding author: Zhong Lin, Email:
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浦燕萍, 顾燕, 杨富, 王春光, 彭文, 方芳, 钟林. 肝移植患者术后多重耐药鲍曼不动杆菌感染影响因素[J]. 中华肝脏外科手术学电子杂志, 2016, 05(03): 158-162.

Yanping Pu, Yan Gu, Fu Yang, Chunguang Wang, Wen Peng, Fang Fang, Lin Zhong. Influencing factors of multi-drug resistant Acinetobacter baumannii infection in patients after liver transplantation[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2016, 05(03): 158-162.

目的

探讨肝移植患者术后鲍曼不动杆菌多重耐药状况及其感染的独立危险因素。

方法

回顾性分析2010年1月至2015年6月在上海交通大学附属第一人民医院行肝移植术的257例患者临床资料。所有患者均签署知情同意书，符合医学伦理学规定。其中25例为多重耐药鲍曼不动杆菌感染；男17例，女8例；年龄<50岁10例，≥50岁15例。采用浓度梯度法进行药物敏感性试验，复合纸法进行金属β-内酰胺酶检测，重复序列PCR和凝胶电泳进行细菌基因型检测。对多重耐药鲍曼不动杆菌进行耐药性分析，观察其耐药谱，以及基因型分布和发生感染时间，并分析其感染的影响因素。影响多重耐药鲍曼不动杆菌感染的单因素分析采用χ2检验，多因素分析采用logistic回归分析。

结果

多重耐药鲍曼不动杆菌的发生率为9.7%（25/257）。鲍曼不动杆菌菌株对氨基糖苷类、喹诺酮类、青霉素类、头孢菌素类和碳青霉烯类均表现为高耐药，耐药率100%，且96%（24/25）菌株金属β-内酰胺酶阳性。25株鲍曼不动杆菌可分为3个基因型，分别为B型18株，A型5株，C型2株。术后真菌培养阳性（OR=5.470，95%CI：1.402～21.333，P<0.05）和再次气管插管（OR=11.538，95%CI：2.228～59.742，P<0.05）是多重耐药鲍曼不动杆菌感染的独立危险因素。

结论

肝移植患者术后多重耐药鲍曼不动杆菌感染发生率高,对多种抗生素表现为高耐药，基因型以B型为主。术后真菌培养阳性和再次气管插管是其感染的独立危险因素。

关键词: 肝移植, 多药耐药相关蛋白质类, 鲍氏不动杆菌, 感染
Objective

To explore the multi-drug resistance condition and independent risk factors of Acinetobacter baumannii infection in patients after liver transplantation.

Methods

Clinical data of 257 patients who underwent liver transplantation in Shanghai General Hospital between January 2010 and June 2015 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Twenty-five patients were infected with multi-drug resistant Acinetobacter baumannii. Among the patients, 17 were males and 8 were females, 10 were younger than 50 years old and 15 were older or equal to 50 years old. Drug sensitive test was detected using concentration gradient method, metallo-beta-lactamase was detected using composite paper, and bacterial genotype was detected using repetitive sequence polymerase chain reaction (PCR) and gel electrophoresis. Drug resistance, drug-resistant spectrum, genotype distribution, infection time and influence factors of infection for multi-drug resistant Acinetobacter baumannii were observed and analyzed. Single-factor analysis of multi-drug resistant Acinetobacter baumannii was conducted using Chi-square test and multiple-factor analysis was conducted using logistic regression analysis.

Results

The incidence of multi-drug resistant Acinetobacter baumannii infection was 9.7%(25/257). Acinetobacter baumannii strains were highly resistant to aminoglycosides, quinolones, penicillins, cephalosporins and carbapenems, with the drug resistance of 100%. In addition, 96%(24/25) of the strains were metallo-beta-lactamase positive. Three genotypes were observed in the 25 strains of Acinetobacter baumannii: type B (n=18), type A (n=5) and type C (n=2). Positive postoperative fungal culture (OR=5.470, 95%CI: 1.402-21.333, P<0.05) and re-intubation (OR=11.538, 95%CI: 2.228-59.742, P<0.05) were the independent risk factors for multi-drug resistant Acinetobacter baumannii infection.

Conclusions

The incidence of multidrug-resistant Acinetobacter baumannii infection in patients after liver transplantation is high. Multidrug-resistant Acinetobacter baumannii is highly resistant to multiple antibiotics, and type B is the main genetype. Positive postoperative fungal culture and re-intubation are the independent risk factors for multi-drug resistant Acinetobacter baumannii infection.

Key words: Liver transplantation, Multidrug resistance-associated proteins, Acinetobacter baumannii, Infection
表1 鲍曼不动杆菌对九种抗生素耐药性的检测
抗生素 MIC50（μg/ml） MIC90（μg/ml） 耐药率(%)
庆大霉素 >32 >32 100
哌拉西林钠 >256 >256 100
头孢噻肟钠 >128 >128 100
头孢他啶 >64 >64 100
头孢吡肟 >64 >64 100
环丙沙星 >8 >8 100
哌拉西林钠/他唑巴坦钠 >256/4 >256/4 100
亚胺培南 >32 >32 100
美罗培南 >32 >32 100
表2 多重耐药鲍曼不动杆菌感染的logistic多因素分析
? OR 95%CI P值
术后真菌培养阳性 5.470 1.402～21.333 0.014
再次气管插管 11.538 2.228～59.742 0.004
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