目的 了解江苏省人民医院肝移植术后感染病原菌的分布及耐药性,为临床合理用药提供参考。方法 对2012年1月—2015年1月江苏省人民医院肝移植术后感染病原菌的分布及耐药性进行统计分析。结果 共分离出病原菌1 380株,主要来源于痰液标本。病原菌分布以革兰阴性菌为主,占69.57%,革兰阳性菌和真菌分别占20.07%、10.36%;其中革兰阴性菌以鲍曼不动杆菌、肺炎克雷伯菌为主,革兰阳性菌以溶血葡萄球菌为主;革兰阴性菌对美罗培南、阿米卡星、亚胺培南较为敏感,耐药率均低于30%,对头孢曲松、氨曲南等的耐药率均较高;革兰阳性菌对万古霉素、利奈唑胺、替考拉宁较为敏感,耐药率均低于20%,对氨苄西林、诺氟沙星等耐药率均较高。结论 肝移植术后感染病原菌的构成主要是鲍曼不动杆菌、肺炎克雷伯菌和溶血葡萄球菌,临床选择抗菌药物时建议选用病原菌表现较低耐药性的美罗培南、阿米卡星、万古霉素、利奈唑胺等药物。

Objective To investigate the distribution and drug resistance of pathogenic bacteria infected after liver transplantation in Jiangsu Province Hospital, and to provide reference for clinical reasonable use of antibiotics. Methods The distribution and drug resistance of pathogenic bacteria infected after liver transplantation in Jiangsu Province Hospital from January 2012 to January 2015 were statistically analyzed. Results Totally 1 380 strains of pathogens were isolated, and the pathogenic bacteria was isolated mainly from sputum samples. Gram-negative bacteria were the main pathogenic bacteria and accounted for 69.57%. Gram-positive bacteria and fungus accounted for 20.07% and 10.36%, respectively. Gram-negative bacteria mainly consisted of Acinetobacter bauamnnii and Klebsiella pneumoniae. Gram-positive bacteria mainly consisted of Staphylococcus haemolyticus. Main Gram-negative bacteria were sensitive to meropenem, amikacin, and imipenem, and the drug resistance rate was lower than 30%. And they were highly resistant to ceftriaxone and aztreonam. Main Gram-positive bacteria were sensitive to vancomycin, linezolid, and teicoplanin and the drug resistance rate was lower than 20%. And they were highly resistant to ampicillin and norfloxacin. Conclusion The main pathogens infected after liver transplantation are A. baumannii, K. pneumoniae, and S. aureus, and it is suggested to choose antimicrobial drugs with lower resistance, such as meropenem, amikacin, vancomycin, and linezolid.

江苏省六大人才高峰基金项目(NO2014-WSW-005)