中华肝胆外科杂志
中華肝膽外科雜誌
중화간담외과잡지
CHINESE JOURNAL OF HEPATOBILIARY SURGERY
2014年
10期
710-714
,共5页
康永振%孙晓叶%刘懿禾%邓永林%潘澄%郑虹%张坚磊%高伟%蒋文涛
康永振%孫曉葉%劉懿禾%鄧永林%潘澄%鄭虹%張堅磊%高偉%蔣文濤
강영진%손효협%류의화%산영림%반징%정홍%장견뢰%고위%장문도
肝移植%胆道真菌感染%耐药性%预后
肝移植%膽道真菌感染%耐藥性%預後
간이식%담도진균감염%내약성%예후
Liver transplantation%Biliary tract fungal infection%Drug resistance%Prognosis
目的 探讨肝移植术后胆道真菌感染的临床诊断和治疗.方法 回顾性分析我院肝移植科2003年1月至2013年9月送检的肝移植患者术后胆汁标本中56例113份真菌阳性菌株的胆汁培养结果和药敏结果.结果 56例患者有39例(69.6％)诊断为肝移植术后胆道真菌感染.共检出真菌92株,其中白色念珠菌72株(78.3％),热带念珠菌14株(15.2％),葡萄牙念珠菌3株(3.3％),阿氏丝孢念珠菌、吉利蒙念珠菌、克鲁氏念珠菌各检出1株(各占1.1％).术后1个月内病原菌检出率最高[54.3％ (50/92)].主要病原菌白色念珠菌和热带念珠菌的总耐药率为3.87％,对临床常用抗真菌药物敏感性在90％以上;胆道真菌感染患者病死率为23.1％,并发胆道外其他器官感染和感染性休克显著增加肝移植术后胆道真菌感染患者的病死率.结论 肝移植术后1个月内是真菌感染高发期,对于怀疑胆道真菌感染的患者要及时用药.
目的 探討肝移植術後膽道真菌感染的臨床診斷和治療.方法 迴顧性分析我院肝移植科2003年1月至2013年9月送檢的肝移植患者術後膽汁標本中56例113份真菌暘性菌株的膽汁培養結果和藥敏結果.結果 56例患者有39例(69.6％)診斷為肝移植術後膽道真菌感染.共檢齣真菌92株,其中白色唸珠菌72株(78.3％),熱帶唸珠菌14株(15.2％),葡萄牙唸珠菌3株(3.3％),阿氏絲孢唸珠菌、吉利矇唸珠菌、剋魯氏唸珠菌各檢齣1株(各佔1.1％).術後1箇月內病原菌檢齣率最高[54.3％ (50/92)].主要病原菌白色唸珠菌和熱帶唸珠菌的總耐藥率為3.87％,對臨床常用抗真菌藥物敏感性在90％以上;膽道真菌感染患者病死率為23.1％,併髮膽道外其他器官感染和感染性休剋顯著增加肝移植術後膽道真菌感染患者的病死率.結論 肝移植術後1箇月內是真菌感染高髮期,對于懷疑膽道真菌感染的患者要及時用藥.
목적 탐토간이식술후담도진균감염적림상진단화치료.방법 회고성분석아원간이식과2003년1월지2013년9월송검적간이식환자술후담즙표본중56례113빈진균양성균주적담즙배양결과화약민결과.결과 56례환자유39례(69.6％)진단위간이식술후담도진균감염.공검출진균92주,기중백색념주균72주(78.3％),열대념주균14주(15.2％),포도아념주균3주(3.3％),아씨사포념주균、길리몽념주균、극로씨념주균각검출1주(각점1.1％).술후1개월내병원균검출솔최고[54.3％ (50/92)].주요병원균백색념주균화열대념주균적총내약솔위3.87％,대림상상용항진균약물민감성재90％이상;담도진균감염환자병사솔위23.1％,병발담도외기타기관감염화감염성휴극현저증가간이식술후담도진균감염환자적병사솔.결론 간이식술후1개월내시진균감염고발기,대우부의담도진균감염적환자요급시용약.
Objective To explore the clinical diagnosis and treatment of biliary fungal infection after liver transplantation.Methods The results of bile culture and drug resistance test of 113 bile specimens taken from 56 patients who received liver transplantation during January 2003 and September 2013 were retrospectively analysed.Results 39 of 56 patiens(69.6％) had fungal infection.A total of 92 fungi strains were detected,including 72 strains (78.3％) of Candida albicans,14 strains (15.2％) of Candida tropicalis,3 strains(3.3％) of Candida lusitaniae and 1 strains(1.1％) of Trichosporon asahii,Candida guilliermondii and Candida krusei; 54.3％ of pathogens(50/92)developed within the first month after liver transplantation,total drug resistence of Candida albicans and Candida tropicalis was 3.87％ and more than 90％ strains were sensitive to antifungal drugs that usually used in clinic.Total mortality was 23.1％ and the death rate increased obviously if multi-organ infections or septic shock were concurrent with biliary fungal infection.Conclusions Biliary fungal infection is more likely to happen within the first month after liver transplantation.Sensitive medicine should be used in time for the patients who are suspicious of undergoing biliary fungi infection.
