R.P. Singh, A.C. Farney, J. Rogers, E. Ashcraft, L. Hart, W. Doares, E.L. Hartmann, A. Reeves-Daniel, P.L. Adams, R.J. Stratta

目标：本研究的目标是审查胰腺移植（PTX）后的发病率、风险因素和菌血性带来的影响。

方法：我们对2002年1月至2007年4月期间进行胰肾同步联合移植（SKPT）和单独PTX的患者进行了回顾性分析。感染和其他属性均与血培养阳性有关。

结果：在110名肠内引流式PTX患者中，包括80名SKPT患者和30名单独PTX患者。对这些患者进行的平均随访时间为32 个月。29名患者（26%）出现了菌血性，其中5例（17%）为复发性；13例（12%）出现在移植后的第1个月，12例（11%）出现在术后第1至3个月，3例（3%）出现在3至12个月，3例（3%）出现在术后第一年。典型的有机体为：MRSE、MSSE、克雷白氏杆菌（Klebsiella）、大肠杆菌、万古霉素耐药肠球菌（VRE）以及不动杆菌。20例患者（69%）的手术部位感染与菌血性有关，包括深度腹部切开（31%）、线（31%）、泌尿道（34%）、肺部（7%）。15例患者（52%）的血液中出现了相似的菌株。这与巨细胞病毒（CMV）感染并没有相关性。在第1年，菌血性更多的是与急性排斥反应（32% vs 17%；P = .09）、手术并发症（54% vs 42%；P = .267）、死亡率（11% vs 4%；P = .15）、胰腺存活率（14% vs 9%；P = .39）和移植肾失功能（4% vs 0；P = .08）有关。与rATG诱导相比，菌血症患者更少采用alemtuzumab（分别为39%和14%；P = .04）。

结论：在PTX术后三个月时间内出现菌血性是常见的。相当数目的患者（39%）有多重耐药性。大部分患者同时出现了腹部感染、泌尿系感染和线性感染。菌血性与排斥反应率、死亡率以及移植物失功能的概率偏高有关系。

Analysis of Bacteremia After Pancreatic Transplantation With Enteric Drainage
R.P. Singh, A.C. Farney, J. Rogers, E. Ashcraft, L. Hart, W. Doares, E.L. Hartmann, A. Reeves-Daniel, P.L. Adams, R.J. Stratta

Objective：The objective of this study was to review the incidence, risk factors, and impact of bacteremia after pancreas transplantation (PTX).

Methods：We performed a retrospective analysis of consecutive simultaneous kidney-pancreas transplantations (SKPTs) and solitary PTXs from January 2002 through April 2007. Positive blood cultures were correlated with other coexisting infections and parameters.

Results：One hundred ten PTXs with enteric drainage included 80 SKPTs and 30 solitary PTXs. Mean follow-up was 32 months. Bacteremia occurred in 29 (26%) patients with 5 (17%) being recurrent; it was seen during the first month after transplantation in 13 (12%), between 1 and 3 months in 12 (11%), between 3 and 12 months in 3 (3%), and after the first year in 3 cases (3%). Typical organisms were as follows: MRSE, MSSE, Klebsiella, Escherichia coli, vancomycin-resistant enterococci (VRE), and Acinetobacteri. Bacteremia was associated with coexisting site infection in 20 cases (69%): deep abdominal wound (31%); line (31%); urinary tract (34%); and pulmonary (7%). Similar bacterial species in blood and a coexisting site occurred in 15 cases (52%). No correlation was seen with cytomegalovirus (CMV) infections. In the first year, bacteremia was associated with more acute rejection episodes (32% vs 17%; P = .09), surgical complications (54% vs 42%; P = .267), mortality (11% vs 4%; P = .15), and death-censored pancreatic (14% vs 9%; P = .39) and kidney (4% vs 0; P = .08) graft loss. Fewer patients with bacteremia received alemtuzumab compared with rATG induction (14% vs 39%; P = .04).

Conclusions：Bacteremias were common within 3 months of PTX. A significant number (39%) were multidrug resistant. The majority were accompanied by abdominal, urinary, or line infections. Bacteremias were associated with slightly higher incidences of rejection, mortality, and graft loss.

Volume 40, Issue 2, Pages 506-509

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