目的 探讨肾移植患者中供肾灌洗液培养出耐碳青霉烯类肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumoniae, CRKP)的防治策略。方法 总结2020-05至2021-01行肾移植手术、供肾灌洗液培养为CRKP的12例肾移植患者的治疗经过。结果 12例均在获知灌洗液培养结果后及时予以治疗,其中4例使用大剂量美罗培南延长输注联合磷霉素,7例使用头孢他啶阿维巴坦联合氨曲南或磷霉素,1例联用多黏菌素、大剂量美罗培南延长输注与磷霉素。除1例受者出现一过性体温升高外,其余均无明显不适,但白细胞、中性粒细胞、降钙素原等有不同程度的升高。12例中,4例引流液培养为CRKP,1例引流液培养为屎肠球菌后加用利奈唑胺,其余均为仅灌洗液培养阳性。所有患者经治疗后未发生肾动脉破裂、移植肾切除或死亡,出院时血肌酐水平在79.8～202.5 μmol/L。结论 供肾灌洗液培养为CRKP的阳性结果应尽早防治,根据药敏结果、药品可获得性等制定给药方案。
Abstract
Objective To investigate ways to deal with Carbapenem-resistant Klebsiella pneumoniae (CRKP) in preservation fluids (PF).Methods The treatment processes and outcomes of 12 kidney transplant recipients with CRKP in PF detected between May 2020 and January 2021 were retrospectively analyzed.Results All the patients received quick treatment after CRKP tested positive in their PF. Four of the patients received extended infusion of meropenem combined with fosfomycin, 7 received extended infusion of ceftazidime-avibatam combined with amtriaxanthin or fosfomycin, and 1 received extended infusion of polymyxin combined with extended infusion of meropenem and fosfomycin. There was no obvious discomfort except one patient with a transient temperature increase, but the levels of leukocytes, neutrophils and procalcitonin increased among these patients. Of the 12 recipients, 4 cases were cultured as CRKP in PF, 1 case as Enterococcus faecium and treated with linezolid, and the rest were only positive in PF. No renal artery rupture, renal transplant resection or death occurred in these patients, and the serum creatinine levels ranged from 79.8 to 202.5 μmol/L at discharge.Conclusions CRKP in PF deserves more attention. Treatment regimens should vary according to drug sensitivity results and drug availability.
关键词
肾移植 /
耐碳青霉烯类肺炎克雷伯菌 /
灌洗液培养 /
美罗培南 /
多黏菌素 /
头孢他啶阿维巴坦
Key words
kidney transplant /
Carbapenem-resistant Klebsiella pneumoniae /
preservation fluids /
meropenem /
polymyxin /
ceftazidime-avibatam
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基金
北京市医院管理局消化内科学科协同发展中心专项经费(XXZ06)
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