目的 探讨肾移植受者术后医院感染病原菌及其危险因素.方法 回顾性分析2019年1月—2023年12月于上海交通大学医学院附属仁济医院接受肾移植手术受者术后感染部位、感染率、感染病原体,收集患者基本资料、供肾情况、ICU和住院资料、术中及术后抗菌药物使用情况等,采用Logistic回归分析归纳肾移植受者术后医院感染的危险因素.结果 1 863例肾移植术后医院感染例次发生率为3.49％,以肺部感染与血流感染为主;肾移植术后医院感染会导致术后住院天数、术后用药天数以及术后住ICU天数的增加(P＜0.001);供肾带菌(OR=2.334,95％CI:1.579～3.450,P＜0.001)是肾移植术后发生医院感染的危险因素;术前使用抗菌药物(OR=0.399,95％CI:0.185～0.863,P=0.020)、术后 48 h 二联预防使用(OR=0.133,95％CI:0.064～0.275,P＜0.001)及三联预防使用(OR=0.263,95％CI:0.120～0.573,P=0.001)是肾移植术后发生医院感染的保护因素.结论 肾移植术后医院感染会导致住院天数、用药天数等医疗成本的增加,供肾带菌会导致肾移植术后医院感染的风险增加,而术后二联预防使用抗菌药物相较于其他联合方案可更好地降低医院感染风险.
Risk factors for postoperative nosocomial infections in renal transplant recipients and pathogens
OBJECTIVE To investigate the risk factors of postoperative nosocomial infections in renal transplant re-cipients and analyze the pathogens.METHOD The site of postoperative infection,infection rate,and pathogens of infection in renal transplant recipients who underwent kidney transplantation at Renji Hospital of Shanghai Jiao-tong University School of Medicine from Jan.2019 to Dec.2023 were retrospectively analyzed,and the basic infor-mation of the patients,kidney donor status,ICU and hospitalization information,and the use of antimicrobials in the intraoperative and postoperative period were collected,and the risk factors for postoperative nosocomial infec-tions in renal transplant recipients were summarized by logistic regression analysis.RESULTS The incidence rate of nosocomial infections after kidney transplantation was 3.49％ in 1 863 cases,with lung and blood stream infections predominating.Nosocomial infections after kidney transplantation led to an increase in postoperative hospitalization days(P＜0.001),postoperative medication days(P＜0.001),and postoperative ICU days(P＜0.001).Regres-sion analysis showed that whether the donor kidney was contaminated(OR=2.334,95％ CI:1.579-3.450,P＜0.001)were the risk factor for nosocomial infections after kidney transplantation.Preoperative use of antibiotics(OR=0.399,95％ CI:0.185-0.863,P=0.020),the use of antibiotics in a two-drug regimen for 48 hours after surgery(OR=0.133,95％ CI:0.064-0.275,P＜0.001),and the use of antibiotics in a three-drug regimen after surgery(OR=0.263,95％ CI:0.120-0.573,P=0.001)were all protective factors for the occurrence of hospital infection after kidney transplantation.CONCLUSION After kidney transplantation,nosocomial infection may lead to an increase in medical costs such as days of hospitalization and days of medication,and donor kidneys carrying pathogenic bacteria led to an increase risk of hospital infection after kidney transplantation,while the use of antibi-otics in diphtheria prophylaxis after surgery reduced the risk of hospital-acquired infections better when compared to other combined regimens.
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