Study On Risk Factors And Pathogenic Of Infection After Organ Transplant

Objectives To get the information of characteristics of post transplant infections and the pathogenic distribution,we investigate the rate and time of the infection happened after transplantation,analyze the main risk factors to infection,the pathogenic isolated and their sensitivity as well as the influence of administration of antibacterial.This study will provider the base information for the prevention and treatment to the infections of post organ transplant.Methods1.Eleven factors which may contributed to the post transplant infections according to the published literatures were recorded.Then,we analyzed infection rate of different stages,the infection sites and the risk factors of infection.At the same time,we transferred the primary information into data files,and then followed by a statistical analysis.2.We recorded and analyzed the results of bacteria and fungi culture of blood,sputum, medistream urine,stool,hydroperitonia,draining fluid of abdominal cavity,swallow awab for patients with transplant.We conjuncted the symptom and physical signs of victims with the culture results of pathogenic bacterium,judged the infection sites, pathogenic distribution and their sensitivity.3.We have built the evaluation criterion of antibacterial rational use according to《guide book of antibacterial clinical application》.We noted the breeds,application, dosage,time course,and combination of the antibacterials and analyzed the situations of antibacterial prophylactic and remedial administration in organ transplant patients respectively.Results1.infections occurred in 121 infections out of 244 cases of patients,accounting for 49.6%,during the period of 1 days to 1 year after operation;1 month after operation was the high-occur period of infections,accounting for 56.2%,26,17 and 9 cases suffered from postoperative infection at 2-3 months,4-6mon,over 6 months respectively,accounting for 21.5%,14.0%and 7.4%respectively.It included mainly pulmonory infection,then followed by urinary,abdominal and biliary infection.The statistic analysis of possible risk factors for organ transplant infection demonstrated that the effective intensity of postoperative infection were tracheal intubations,dwell catheter,hyperglucosemia,hypoproteinemia,anaemia after operation and patients over 60 years old.2.Gram-positive coccus(G~+)was detected in 162 stocks(all 417 stocks of pathogenic bacteria),Staphylococcus epidermidis,Staphylococcus aureus,E.faecalis,E.f aecium,Streptococcus D group occupied the first five.Gram-Negative bacillus(G~-) was detected in 145 strain,most were Pseudomonas aeruginosa,followed by Escherich's bacillus,klebsiella pneumoniae,acinetobacter baumannii,Pseudomonas maltophilia,Enterobacter cloacae etc.There were also 90 stocks of fungi,by turns of Candida albicans,Candida tropicalis,Candida glabrate,thread fungus and Candida krusei.Results of drug susceptibility testing displayed;Staphylococcus epidermidis and Staphylococcus aureus has a multidrug resistance of＞50.0%in G~+,no vancomycin resistant staphylococcus was detected;G~- had a low resistant rate to imipenem,however,Pseudomonas maltophilia was natual resistant to it;Candida albicans was susceptive to four antifungals---5FC,fluconazole,itraconazole and amphotericin B.3.100%organ transplant patients took antimicrobials,no infection of incisional wound occured.Intravenous drip administration of prophylactic antimicrobials (mainly single breed)was commonly used,and 59%of there were third generation cephalosporin,with an average time course of 7 days.Therapeutical antimicrobials included 12 classes-19 breeds,with average mean 4 breeds per patient,the most frequently used ceftazidime seize 16.6%.The longest continuous administration of antimicrobials was 38 days,while the longest administration of single breed and drugs combination were 27 and 10 days,respectively.Conclusion1.Characteristics of infections are similar in different types of transplantation.The risk factors post-transplant infection are trachea intubations catheterization,diabetes mellitus,hypohemia hypoalbuminemia and over 60 years old.2.Pathogens mainly include Staphylococci,Enterococci,Pseudomonas aeruginosa and Candida albicans,no vancomycin resistant Staphylococci and Enterococci detected.Mixed infection of high-resistant bacteria and fungi was one of the significant reasons of postoperative death.Mixed infections of high-resistant bacteria and fungi are one of the important factors leading to death for post transplant patients.3.Problems were existed both in infection prophylaxis and treatment,such as the wrong time of the antibacterial initiated,no addition of drug for the operation with over 3 hours long,and time for infection prophylaxis is too long in the infection prevention.For the infection treatment,there were many serious problems; mal-opportunity and high expense of medication,prolonged time course of drug use, frequent change of drugs,bind and strong-strong drugs combinations.