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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 ›› 2019, Vol. 08 ›› Issue (06) : 502 -506. doi: 10.3877/cma.j.issn.2095-3232.2019.06.009

所属专题： 文献；

临床研究

肝移植受者术后肺炎克雷伯菌感染特征分析
谢芝芝1, 霍玮2, 陆平兰3, 傅斌生3, 徐长志1, 朱冬林1, 刘剑戎3, 席云1,†()   
  1. 1. 510630　广州，中山大学附属第三医院岭南医院检验科
    2. 510640　广州，广东省农业科学院动物卫生研究所
    3. 510630　广州，中山大学附属第三医院肝移植中心
  • 收稿日期:2019-08-08 出版日期:2019-12-10
  • 通信作者: 席云

Feature of Klebsiella pneumoniae infection in recipients after liver transplantation

Zhizhi Xie1, Wei Huo2, Pinglan Lu3, Binsheng Fu3, Changzhi Xu1, Donglin Zhu1, Jianrong Liu3, Yun Xi1,†()   

  1. 1. Clinical Laboratory, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
    2. Institute of Animal Health, Guangdong Academy of Agricultural Sciences, Guangzhou 510640, China
    3. Liver Transplantation Center of Lingnan Hospital, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
  • Received:2019-08-08 Published:2019-12-10
  • Corresponding author: Yun Xi
  • About author:
    Corresponding author: Xi Yun, Email:
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引用本文：

谢芝芝, 霍玮, 陆平兰, 傅斌生, 徐长志, 朱冬林, 刘剑戎, 席云. 肝移植受者术后肺炎克雷伯菌感染特征分析[J]. 中华肝脏外科手术学电子杂志, 2019, 08(06): 502-506.

Zhizhi Xie, Wei Huo, Pinglan Lu, Binsheng Fu, Changzhi Xu, Donglin Zhu, Jianrong Liu, Yun Xi. Feature of Klebsiella pneumoniae infection in recipients after liver transplantation[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2019, 08(06): 502-506.

目的

探讨肝移植受者术后肺炎克雷伯菌（KP）感染的临床特点及病原学特征。

方法

回顾性分析2015年1月至2018年12月中山大学附属第三医院岭南医院诊治的54例肝移植术后KP感染患者临床资料。其中男48例，女6例；年龄7个月～75岁，中位年龄54岁。分析KP感染发生、分布及耐药性。PCR检测2018年33株耐碳青霉烯肺炎克雷伯菌（CRKP）携带的常见碳青霉烯酶基因（blaIMP、blaKPC等）和β-内酰胺酶基因（blaSHV）情况。

结果

同期共完成699例肝移植，KP感染率7.7%（54/699）,其中CRKP感染率5.2%（36/699）。KP和CRKP感染率逐年增加，KP感染率2018年达高峰（9.7%），CRKP感染率2017年达高峰（7.7%）。KP和CRKP的感染时间集中在术后30 d内，占比分别为80%及81%。78株KP主要来源于呼吸道，其次分别是腹腔及血液。KP的多部位检出率逐年上升。药物敏感分析显示KP对于青霉素类、头孢菌素类、碳青霉烯类及喹诺酮类药物耐药率逐年上升，在2017年达高峰；对于氨基糖苷类和氨曲南，2017年耐药率达最高；对于复方新诺明和四环素，2016年的耐药率最高。耐药基因检测显示33株CRKP中有16株携带blaKPC基因，3株CRKP携带blaIMP基因。

结论

肝移植受者术后KP感染以呼吸道为主，早期流行，多部位感染呈增长趋势，CRKP比例有所增加，耐药机制主要以产碳青霉烯酶为主，临床应加强早期综合防治，合理用药。

关键词: 肝移植, 感染, 克雷伯菌，肺炎, 碳青霉烯酶
Objective

To investigate the clinical and etiological characteristics of Klebsiella pneumoniae (KP) infection in the recipients after liver transplantation.

Methods

Clinical data of 54 patients infected with KP after liver transplantation in Lingnan Hospital, the Third Affiliated Hospital of Sun Yat-sen University from January 2015 to December 2018 were retrospectively analyzed. Among them, 48 patients were male and 6 female, aged from 7 months to 75 years with a median age of 54 years. The incidence, distribution and drug resistance of KP infection were analyzed. The expression levels of common carbapenemase genes (blaIMP, blaKPC, etc.) and β-lactamase gene (blaSHV) carried by 33 strains of carbapenem-resistant Klebsiella pneumoniae (CRKP) isolated in 2018 were quantitatively measured by PCR.

Results

A total of 699 cases of liver transplantation were performed in the same period. The KP infection rate was 7.7%(54/699), of which CRKP infection rate was 5.2%(36/699). The KP and CRKP infection rates increased year by year. The KP infection rate reached the peak at 9.7% in 2018, and the CRKP infection rate peaked at 7.7% in 2017. Approximately 80% and 81% of KP and CRKP infection occurred within postoperative 30 d.78 KP strains were mainly derived from respiratory tract, followed by abdominal cavity and blood. The detection rate of KP in multiple sites increased year by year. Drug sensitivity analysis demonstrated that the drug resistance rate of KP to penicillins, cephalosporins, carbapenems and quinolones elevated year by year, reaching the peak in 2017. The drug resistance rate towards aminoglycosides and aztreonam was the highest in 2017, and the drug resistance rate to compound sulfamethoxazole and tetracycline reached the peak in 2016. Drug resistance gene detection revealed that 16 of 33 CRKP strains carried blaKPC gene and 3 CRKP strains carried blaIMP gene.

Conclusions

KP infection primarily occurs in the respiratory tract of the recipients undergoing liver transplantation, which is prevalent in the early stage with an increasing tendency of multiple-site infection. The proportion of CRKP infection may increased. The main mechanism underlying drug resistance is producing carbapenemase. Comprehensive prevention and treatments and rational use of medicine should be carried out early in clinical practice.

Key words: Liver transplantation, Infection, Klebsiella pneumonia, Carbapenemase
表1 肝移植术后KP及CRKP感染率
年份 肝移植术（例） KP (例) KP感染率（%） CRKP （例） CRKP感染率（%）
2015 93 6 6.5 1 1.1
2016 141 7 5.0 3 2.1
2017 196 15 7.7 15 7.7
2018 269 26 9.7 17 6.3
合计 699 54 7.7 36 5.2
表2 肝移植术后KP感染部位
年份 KP感染（例） 单部位（例） 单部位检出率（%） 多部位（例） 多部位检出率（%）
2015 6 6 100 0 0
2016 7 6 86 1 14
2017 15 11 73 4 27
2018 26 19 73 7 27
合计 54 42 78 12 22
表3 肝移植术后KP对抗菌药物的逐年耐药率（%）
抗菌药物 2015年 2016年 2017年 2018年
阿莫西林/克拉维酸（氨苄西林/舒巴坦） 17 43 100 73
哌拉西林/他唑巴坦 0 43 87 62
头孢唑啉 33 71 100 81
头孢呋辛 50 71 100 81
头孢他啶 0 57 100 77
头孢曲松 17 71 100 81
头孢噻肟 33 71 100 81
头孢吡肟 17 71 100 81
头孢西丁 33 43 100 65
氨曲南 17 71 93 69
厄他培南 0 43 100 65
亚胺培南 17 14 93 65
美罗培南 0 29 100 65
阿米卡星 0 43 73 23
庆大霉素 0 43 80 31
妥布霉素 0 43 73 31
环丙沙星 0 43 80 54
左旋氧氟沙星 0 43 67 54
复方新诺明 17 71 67 58
四环素（替加环素） 33 57 14 0
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