Analysis On The Risk Factors Of Perioperative Infections And On The Rational Antimicrobial Prophylaxis In Renal Transplant Recipients

Background and Objective Infection is the most common complication after renal transplantation,and it is also the main cause of renal allograft failure and recipient death.Therefore,strengthening the prevention and treatment of infection after renal transplantation is the key to ensure the success of renal transplantation.The risk of infection in transplant recipients is determined primarily by three factors: epidemiological exposure,the net state of immunosuppression and the use of effective prophylactic antimicrobials.The purpose of this study is to investigate the epidemiological characteristics of perioperative infection,to explore the risk factors that may affect infection,and to analyze the rationality of antimicrobial prophylaxis,providing a basis for the formulation of norms for the use of antibiotics in renal transplantation.Research methods 1.Investigation on epidemiological characteristics for perioperative infection in renal transplant recipients We collected the information of recipients who received renal transplantation in our hospital from January 2015 to March 2019,and recorded the incidence of infection,the site of infection,the results of detected pathogens and drug sensitivity tests,as well as the pathogens detected by donors.2.Study on risk factors for perioperative infection in renal transplant recipients We collected the information of the recipients who received renal transplantation in our hospital from January 2015 to March 2019,and recorded their basic conditions before operation,during operation and after operation.The patients with infection were set as the infection group,and those without infection as the control group.Chi-square test was used for univariate analysis to find out the possible influencing factors,and then Logistic regression analysis was used to determine the independent risk factors for perioperative infection in renal transplant recipients.3.Analysis of rationality of antimicrobial prophylaxis in renal transplant recipients during the perioperative period We divided the recipients into two groups: the high-level preventive drug group and the low-level preventive drug group.Chi-square test was used to compare the infection rates of two groups and the effect of antimicrobial prophylaxis on fungal positive report.We counted the results of drug sensitivity tests of all detected strains from 2016 to 2018.Results 1.Investigation on epidemiological characteristics for perioperative infection in renal transplant recipients A total of 303 renal transplant recipients were included in this study,including 212 males and 91 females.The infection rate during the perioperative period was 9.90%(30 cases),and most of them were nosocomial infections(29 cases,96.67%).The most common infection was pulmonary infection in 12 cases(40.00%),followed by perirenal infection(8 cases,26.67%),and urinary tract infection(4 cases,13.33%).The main pathogen was gram-negative bacteria,and the detection rate was 66.67%.Among the main gram-negative bacteria,indole-producing chrysanthemum aureus was fully resistant to common antibiotics except compound sulfamethoxazole.The resistance rate of klebsiella pneumoniae to ceftriaxone was 100%,and the resistance rate to ceftazidime,imipenem and meropenem was 75%.The resistance rate of enterococci to streptomycin and tetracycline was 25.00%,and the resistance rate to ampicillin,penicillin,gentamicin,ciprofloxacin,levofloxacin and dafoptin was 50.00%.The infection rate in DCD renal transplant recipients was significantly higher than that in living donor renal transplant recipients.2.Study on risk factors for perioperative infection in renal transplant recipients Univariate analysis showed that the source of donor,the length of hospital stay,the duration of dialysis,intraoperative blood transfusion,the postoperative use of different immunosuppressive regimens and perirenal hemorrhage after operation were related to the occurrence of perioperative infection in renal transplant recipients.Multivariate Logistic regression analysis showed that intraoperative blood transfusion(OR=3.973,95%CI=1.092-14.455)and the postoperative immunosuppressive regimen of MMF combined with cyclosporine and hormone(OR=6.404,95%CI=1.216-33.717)were independent risk factors for perioperative infection in renal transplant recipients.3.Analysis of rationality of antimicrobial prophylaxis in renal transplant recipients during the perioperative period Through a retrospective study,it was found that there was no significant difference between infection rates of two groups with different levels of antimicrobials,and there was no significant difference between the positive rates of fungi of two groups with or without antimicrobial prophylaxis.The drug resistance data of the strains showed that the drug resistance rates of all strains increased year by year from 2016 to 2018,including klebsiella pneumoniae.Conclusion Most of the perioperative infections in renal transplant recipients were nosocomial infections,and the main infection site was pulmonary infection.The main pathogen was gram-negative bacteria,and the proportion of multiple drug-resistant bacteria was high.Intraoperative blood transfusion and postoperative immunosuppression of MMF combined with cyclosporine and hormone were independent risk factors for perioperative infection in renal transplant recipients.Prophylactic use of high-level antibiotics could not effectively reduce the perioperative infection rate of renal transplant recipients,but increase the drug resistance of pathogens.Prophylactic use of antifungal drugs could not significantly reduce the positive rate of fungi.