Abstract:

Objective To explore the distribution characteristics of pathogens， antimicrobial resistanceand prognostic factors of perinephric infection after kidney transplantation. Methods clinical data of patients with perinephric infection after kidney transplantation from January 2018 to January 2025 were collected retrospectively，distribution characteristics of pathogens，antimicrobial susceptibility testing results of patients were statistically analyzed.Patients were divided into improved prognosis group and the poor prognosis group according to 14 d prognosis. Thedifferences in clinical data between two groups of patients were compared，and influencing factors for the prognosis of patients with perinephricinfection after kidney transplantation were evaluated. Results A total of 148 patientswith perinephric infections were included in the study，208 strains of pathogenic bacteria were isolated，including gramnegative bacilli （108 strains，51.92%），gram positive bacteria（66 strains，31.73%），mycoplasma hominis（20 strains，9.62%）and fungi（14 strains，6.73%）. The main gram negative bacteria were Pseudomonas aeruginosa and Klebsiella pneumoniae with resistance rates to penicillin. The other bacteria with more than 50% positivity were cephalosporins，carbapenems， aminoglycosides， and quinolones. Fifty-two strains （25%） of multidrug-resistant Gram negative bacteria was detected..The resistance rate of Enterococcus faecium to penicillin and levofloxacin is 100%， and the resistance rates to ampicillin and erythromycin are 91.84% and 87.76%， respectively. The resistance rate of Enterococcus faecalis to penicillin and erythromycin is 64.71%. Multivariate analysis showed that CRPA（OR ＝ 5.257，95%Cl ＝ 2.097~13.177）and CRKP（OR ＝ 10.711，95%Cl ＝ 2.942~38.993）were independent risk factors for the death of patientswith poor prognosis （P ＜ 0.05）. Conclusion Gram negative bacteria are the main cause of perinephric infections after kidney transplantation， and the detection rate of MDRO is high. Perirephric infections of CRPA and CRKP are independent risk factors for the renal transplant recipients. It is necessary for the clinicians to use antimicrobial agents rationally， and strengthen hospital infection monitoring and screen for multidrug-resistant bacteria from donor kidneys before transplantation. 

Key words:

Kidney transplantation ,  , Perirephric infection ,  , Multidrug-resistant bacteria ,  , Fungus ,  , Poor prognosis,  , Influence factor

摘要：

目的 探讨肾移植术后移植肾周感染的病原菌分布、耐药情况及预后影响因素。方法 回顾性收集 2018 年 1 月至 2025 年 1 月西安交通大学第一附属医院进行肾脏移植术后移植肾周感染患者的临床资料，统计分析感染部位病原菌分布及药敏结果，依据 14 d 预后情况，分为预后好转组和预后不良组，比较两组患者临床资料的差异，分析影响移植肾周感染患者预后的因素。结果 共纳入移植肾周感染患者 148 例，分离获得病原菌 208 株，其中革兰氏阴性菌为 108 株（51.92%），革兰氏阳性菌为 66 株（31.73%），人型支原体为20 株（9.62%），真菌为 14 株（6.73%）。主要革兰氏阴性菌铜绿假单胞菌和肺炎克雷伯菌对头孢菌素类、碳青霉烯类、氨基糖苷类以及喹诺酮类药物的耐药率均大于 50%，检出多重耐药的革兰氏阴性菌为 52 株（25.00%）。屎肠球菌对青霉素、左氧氟沙星的耐药率为 100%，对氨苄西林和红霉素的耐药率分别为 91.84%、87.76%，粪肠球菌对青霉素和红霉素耐药率为 64.71%。多因素显示移植肾周感染碳青霉烯类耐药铜绿假单胞菌（carbapenem-resistant Pseudomonas aeruginosa，CRPA）（OR ＝ 5.257，95% Cl ＝ 2.097 ~ 13.177）、移植肾周感染碳青霉烯类耐药肺炎克雷伯菌（carbapenem-resistant Klebsiella pneumoniae，CRKP）（OR ＝ 10.711，95%Cl ＝ 2.942 ~ 38.993）是患者预后不良的影响因素（P ＜ 0.05）。结论 肾移植术后移植肾周感染以革兰氏阴性菌为主，且多重耐药的革兰氏阴性菌检出率高。移植肾周感染 CRPA 和 CRKP 是患者预后不良的独立危险因素，临床应合理规范使用抗菌药物、加强院感监测及移植术前供体肾源多重耐药菌筛查。

关键词:

肾移植 , 肾周感染 , 多重耐药菌 , 真菌 , 预后不良 , 影响因素