【摘要】 目的 研究儿童肝移植术后感染常见的细菌分布及耐药情况。方法 回顾性分析天津市第一中心医院2019-2021年0～14岁儿童肝移植术后病原菌感染资料，统计分析病原菌分布情况和药敏试验结果，比较三年间病原菌分布及耐药情况的变化。结果 2019-2021年天津市第一中心医院肝移植病房共送检917例患儿标本，阳性553例，阴性364例，阳性率为60.3%；送检标本4 476份，阳性1 220份，阳性率27.3%，主要分离自血液（45.1%），腹水（30.4%）以及胆汁分泌物（9.6%）。其中革兰氏阳性菌633株占51.9%，以肠球菌、葡萄球菌为主，肠球菌对克林霉素的耐药率较高，葡萄球菌对青霉素的耐药率较高，其中金黄色葡萄球菌对青霉素的耐药率呈现逐年上升趋势，差异有统计学意义（P <0.05），在2021年出现对利奈唑胺耐药的屎肠球菌；革兰氏阴性菌527株占43.2%，以肺炎克雷伯菌、大肠埃希菌为主，对头孢呋辛、头孢曲松具有较高的耐药率，其中肺炎克雷伯菌对复方新诺明，大肠埃希菌对左氧氟沙星，铜绿假单胞菌对头孢哌酮/舒巴坦和氨曲南的耐药率逐年增加，差异有统计学意义（P <0.05）；真菌及其他病原菌60株占4.9%。结论 儿童肝移植术后发生细菌感染的风险较高，病原菌以革兰氏阳性菌为主，粪肠球菌、铜绿假单胞菌和鲍曼不动杆菌复合菌的检出率呈现逐年上升趋势，需定期进行监测，为临床合理选择抗菌药物提供依据。更多还原

【Abstract】 Objective To study the bacterial distribution and drug resistance of postoperative infection in children after liver transplantation.Methods The data of pathogenic bacteria infection after liver transplantation in children aged 0-14 years from 2019 to 2021 in Tianjin First Central Hospital were retrospectively analyzed,and the distribution of pathogenic bacteria and drug sensitivity test results were statistically analyzed,and the changes of pathogenic bacteria distribution and drug resistance in three years were compared.Results During the study period from 2019 to 2021,a total of 917 specimens were submitted for examination,of which 553 were positive and 364 were negative,with a positive rate of 60.3%.Among 4476 samples,1220 were positive,with a positive rate of 27.3%,mainly isolated from blood(45.1%),ascites(30.4%)and bile secretions(9.6%).Among them,633 gram-positive bacterial accounted for 51.9%,mainly Enterococcus and Staphylococcus epidermis,Enterococcus had a higher resistance rate to clindamycin and Staphylococcus had a higher resistance rate to penicillin.The drug resistance rates of Staphylococcus aureus to penicillin increased year by year,and the differences were statistically significant(P < 0.05).Linezolid resistant Enterococcus faecium emerged in 2021.527 strains of gram-negative bacteria accounted for 43.2%,mainly Klebsiella pneumoniae and Escherichia coli,the cefuroxime,ceftriaxone with high resistance.The drug resistance rates of Klebsiella pneumoniae to cotrimoxazole,Escherichia coli to levofloxacin,and Pseudomonas aeruginosa to cefoperazone/sulbactam and aztreonam increased year by year,and the differences were statistically significant(P < 0.05).60 strains of fungi and other pathogenic bacteria accounted for 4.9%.Conclusion The risk of infection after liver transplantation in children is high,bacteria are mainly Gram-positive bacteria.The detection rate of Enterococcus faecalis,Pseudomonas aeruginosa and Acinetobacter baumannii complex bacteria showed an increasing trend year by year.It is very important to monitor bacterial resistance to provide basis for rational selection of antibacterial drugs in clinical departments.更多还原