某院食管癌患者放化疗后并发肺部感染的病原学特点与危险因素分析

Analysis of Pathogenic Characteristics and Risk Factors of Complicated Pulmonary Infections in Patients with Esophageal Cancer after Chemoradiotherapy in a Hospital

目的:分析医院食管癌(esophageal cancer,ECa)患者放化疗后并发肺部感染的病原学特点与危险因素,为该类患者并发肺部感染的防治提供参考。方法:选取2020年3月—2022年2月医院收治的142例ECa患者的病历资料,根据患者放化疗后是否并发肺部感染将其分为感染组(n=33)和非感染组(n=109),统计和分析患者并发肺部感染的病原学特点与危险因素。结果:142例ECa患者放化疗后并发肺部感染的有33例(感染率为23.24%),其痰标本中共检出病原菌57株,其中革兰阴性菌36株(占63.16%,以铜绿假单胞菌、肺炎克雷伯菌为主)、革兰阳性菌19株(占33.33%,以金黄色葡萄球菌、表皮葡萄球菌为主)和真菌2株(占3.51%);药敏结果显示,铜绿假单胞菌和肺炎克雷伯菌对亚胺培南、庆大霉素、阿米卡星、头孢他啶的耐药率较低(<25.00%);金黄色葡萄球菌和表皮葡萄球菌对万古霉素、利福平、庆大霉素的耐药率较低(<30.00%);回归分析结果显示,肿瘤大小、住院时间和是否合并糖尿病、高血压、慢性阻塞性肺疾病与ECa患者放化疗后是否并发肺部感染具有相关性(P<0.05),而其中住院时间≥14 d、合并高血压和合并慢性阻塞性肺疾病是患者并发肺部感染的独立危险因素(P<0.05)。结论:ECa患者放化疗后并发肺部感染的病原菌主要为革兰阴性菌,其耐药性较强,仅对部分抗菌药物较为敏感,而住院时间≥14 d、合并高血压和合并慢性阻塞性肺疾病是患者并发肺部感染的重要危险因素,临床在诊治该类易感患者时应加强护理防护,减少肺部感染的发生,此外在肺部感染的抗感染治疗时应尽量选用敏感性较强的抗菌药物,以促进患者的康复。

Objective:To investigate the pathogenic characteristics and risk factors of complicated pulmonary infections in patients with esophageal cancer(ECa)after radiotherapy and chemotherapy in the hospital,and to provide reference for the prevention and treatment of pulmonary infections in these patients.Methods:The medical records of142 ECa patients admitted to the hospital from March 2020 to February 2022 were selected.The patients were divided into infected group(n=33)and non-infected group(n=109)according to whether they were complicated with pulmonary infections after radiotherapy and chemotherapy.The pathogenic characteristics and risk factors of pulmonary infections in these patients were counted and analyzed.Results:Among the 142 ECa patients after radiotherapy and chemotherapy,33 cases had complicated pulmonary infections(the infection rate was 23.24%),and 57 strains of pathogenic bacteria were detected in their sputum specimens,including 36 strains of Gram-negative bacteria(accounting for 63.16%,mainly Pseudomonas aeruginosa and Klebsiella pneumoniae),19 strains of Gram-positive bacteria(accounting for 33.33%,mainly Staphylococcus aureus and Staphylococcus epidermidis)and 2 strains of fungi(accounting for 3.51%).The drug susceptibility test results showed that the resistance rates of Pseudomonas aeruginosa and Klebsiella pneumoniae to imipenem,gentamicin,amikacin and ceftazidime were low(less than 25.00%);the resistance rates of Staphylococcus aureus and Staphylococcus epidermidis to vancomycin,rifampicin and gentamicin were low(less than 30.00%).The regression analysis results showed that the tumor size,length of hospital stay,and complications of diabetes,hypertension and chronic obstructive pulmonary disease were related to pulmonary infections of ECa patients after radiotherapy and chemotherapy(P<0.05),among which,hospital stay longer than or equal to 14d and complications of hypertension and chronic obstructive pulmonary diseases were independent risk factors for patients with pulmonary infections(P<0.05).Conclusion:The pathogenic bacteria of pulmonary infections in ECa patients after radiotherapy and chemotherapy are mainly gram-negative bacteria,which are strong in drug resistance and only sensitive to some antibacterials.The hospital stay longer than or equal to 14 days and complications of hypertension and chronic obstructive pulmonary diseases are important risk factors for patients with pulmonary infections.Therefore,nursing and protection should be enhanced for such patients in clinical diagnosis and treatment,to reduce pulmonary infections.In addition,antibacterials with strong sensitivity should be selected as far as possible in the anti-infection treatment of pulmonary infections,so as to promote recovery of patients.