原位肝移植病人术后真菌感染的病原学特点

探讨原位肝移植术后真菌感染的病原学特征及耐药特性,为临床治疗提供依据。分析了2003年1月至2006年6月间,我院原位肝移植患者术后感染真菌的种类、分布及耐药特性。61例原位肝移植患者有19例术后并发真菌感染,感染率为31.1%;共检出52株真菌,以酵母菌感染为主,主要真菌的检出率分别是近平滑假丝酵母菌51.9%(27/52)、白假丝酵母菌23.1%(12/52)、热带假丝酵母菌9.6%(5/52)、季也蒙假丝酵母菌9.6%(5/52)、克柔假丝酵母菌3.8%(2/52)、曲霉菌感染1.9%(1/52)。常见的感染部位依次为呼吸道、肠道、尿道、血液、胆汁。药敏试验显示,51株真菌对常用抗真菌药物两性霉素B(AMB)、制霉菌素(MYS)、5-氟胞嘧啶(5-FC)、酮康唑(KTC)、咪康唑(M IC)、益康唑(ECO)的平均耐药率分别是2.0%、7.8%、9.8%、29.4%、35.3%和41.2%。原位肝移植术后真菌感染是影响患者预后的重要因素之一,临床应该加强肝移植术后真菌感染耐药性的监测。

Post-Operational Pathogenic Characters of Fungal Infection of Orthotopic Liver Transplantation Patients

In order to provide basis for clinical therapy,pathogenic characters and drug-resistance patterns of fungal infection of post-operational of orthotopic liver transplantation 61 cases of the transplantation since January 2003 to June 2006 were investigated.The results showed that 19 cases were accompanied infected by fungi with the infection rate at 31.1%.Altogether 52 fungal strains were examined,mainly yeast,the examined rate respectively were Candida parasilosis 51.9%(27/52),C.albicans 23.1%(12/52),C.tropicalis 9.6%(5/52),C.guilliermondii 9.6%(5/52),C.krusei 3.8%(2/52),and Aspergillus spp.1.9%(1/52).And the common locations of infection successively were respiratory tract,intestine,urethra,blood,and bile.Drug-resistance tests indicated that the resistance rate of 51 fungal strains against common used anti-fungal medicine AMB,MYS,5-FC,KTC,MIC,and ECO were 2.0%,7.8%,9.8%,29.4%,35.3%,and 41.2% respectively.Therefore,fungal infection after orthotopic liver transplantation is one of the important factors of the patients' prognosis,drug-resistance against fungal infection monitoring should be enhanced after liver transplantation operation.