Retrospective Analysis Of Pathogens In Patients With Hospital Acquired Pneumonia After Renal Transplantation

Objective: analyze the distribution and drug allergy of airway secretion of patients in our hospital affected by hospital acquired pneumonia after renal transplant, so as to provide reference for the treatment of lung infection after kidney transplant.Method: a retrospective analysis was made on patients who suffered from hospital acquired pneumonia after kidney transplantation(kidney transplantation group) and patients who suffered from hospital acquired pneumonia not caused by organ transplantation(non-organ-transplantation group) that have been hospitalized in our hospital from Jan 2008 to Dec 2013. Analyze the quantity and species of isolated strains of their airway secretion. X2 testing should be applied to check if there is difference in the constituent ratio of two groups. And analyze the drug susceptibility of hospital acquired pneumonia etiology main pathogenic bacteria after kidney transplantation.Results: among162 hospitalized patients, there are 516 isolated strains, including 269 gram-negative strains(54%), 185 gram-positive strains(37%), 62 fungus(9%). As for gram-negative isolated strains, the most ones are respectively lung klebsiella(23%), baumanii/acinetobacter haemolyticus(17%), stenotrophomonas maltophilia(12%); as for gram-positive isolated strains, the most ones are respectively staphylococcus haemolyticus, staphylococcus epidermidis, streptococcus pneumonia, staphylococcus auricularis, enterococcus faecium, staphylococcus aureus. Isolated 3601 strains from other patients in our hospital, among which, 2179 gram-negative strains(60%), 788 gram-positive strains(22%), 634 fungus(18%). As for gram-negative isolated strains, the most ones are respectively pseudomonas aeruginosa, baumanii /acinetobacter haemolyticus, lung klebsiella, escherichia coli, enterobacter cloacae, stenotrophomonas maltophilia; as for gram-positive isolated strains, the most ones are respectively staphylococcus aureus(30%), staphylococcus haemolyticus(30%), streptococcus pneumonia(23%), staphylococcus epidermidis(7%); the fungus is also mostly candida albicans.Among the main gram positive bacteria that is separated from airway secretion of patients who suffered from hospital acquired pneumonia after kidney transplantation, the susceptibility rate to vancomycin and linezolid are both 100%; The susceptibility rate of main negative bacteria that is separated from airway secretion of patients with hospital acquired pneumonia after kidney transplantation is relatively complex to antibacterial agents. Among the main negative bacteria, klebsiella pneumoniae, escherichia coli and enterobacter cloacae have the highest susceptibility rate to hydrocarbon enzyme alkenes drugs(over 90%), such as meropenem, imipenem, Sulbactam and Cefopcrazone. But the susceptibility rate of acinetobacter baumannii to imipenem is only 40%, while the susceptibility rate of acinetobacter baumannii to Sulbactam and Cefopcrazone is 60%.Conclusion:(1) The constituent ratio of pathogenic bacteria among patients who suffered from pulmonary infection after kidney transplantation and patients who suffered from pulmonary infection not caused by organ transplantation is different, indicating that patients after kidney transplantation are more easily infected by gram positive bacteria after kidney transplantation;(2) As for gram-negative isolated strains, the most ones are respectively lung klebsiella, baumanii/acinetobacter haemolyticus, stenotrophomonas maltophilia,(3) After kidney transplantation, among patients infected by pulmonary positive bacteria, the susceptibility rate to vancomycin and linezolid are both 100%; the susceptibility rate to rifampicin are the lowest in enterococcus faecium(20%), staphylococcus epidermidis 50%, others are over 70%. Therefore, it is a good choice for patients with other positive bacteria except enterococcus faecium.(4) After kidney transplantation, among patients infected by pulmonary negative bacteria, hydrocarbon enzyme alkenes is no better than Cefperazone-Sulbactam. Pseudomonas maltophilia is resistant to imipenem, while the susceptibility rate of it to levofloxacin and cotrimoxazole are both higher than 80%. Therefore, on clinical, it is hard to judge which antibiotic is better for patients infected by pulmonary negative bacteria after kidney transplantation.