肝移植术后胆道真菌感染病原菌特性及预后分析

摘要

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.%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.