肺癌手术患者医院感染的病原菌及相关因素临床分析

Pathogen spectrum and correlative factors of nosocomial infection in patients with lung cancer

背景与目的肺癌是我国最常见的恶性肿瘤之一,外科手术切除仍然是肺癌患者治疗的首选方法。手术后患者的预后与很多因素相关,其中之一就是手术后医院感染。本研究目的在于探讨肺癌手术患者医院感染病原菌的分布及其相关因素,为预防患者手术后医院感染及改善患者预后提供帮助。方法回顾分析1227例肺癌手术患者中113例医院感染病例,并进行统计学处理。结果肺癌患者医院感染病原菌检出率:革兰氏阴性杆菌为64.03%(299/467),以铜绿假单胞菌为主;革兰氏阳性球菌为31.05%(145/467),以金黄色葡萄球菌为主;真菌为4.92%(23/467)。药敏试验结果提示:产超广谱β2内酰胺酶菌(ESBLs)和耐甲氧西林葡萄球菌(MRS)检出率都很高,导致医院感染致病菌对多种抗生素均有较高的耐药性。老年,肥胖,有长期吸烟史,伴发糖尿病、肾功能不全以及使用人工辅助呼吸24h以上为肺癌手术患者发生医院感染的正相关因素。结论对肺癌患者手术后医院感染的相关因素及病原菌应有足够的认识。临床用药应根据致病菌药敏试验结果合理选择使用抗生素,同时强调抗生素的合理使用,以控制致病菌的耐药性。

Background and objective Lung cancer is one of the most common malignant tumors in China. Surgical resection is still the first choice of treatment for most lung cancer patients. The prognosis of lung cancer after surgical treatment is correlated to many factors. One of them is nosocomial infection. This study is to investigate the distribution of the pathogens causing nosocomial infection and its correlative factors in patients with lung cancer. Methods One hundred and thirteen cases that had hospital-acqulred infection out of 1 227 surgically treated patients with lung cancer were analyzed statistically. Results Of all the pathogenic species, the most prevalent species were Gram-negative bacteria with average positive detection of 64.03% （299/467）. The second were Gram-positive bacteria （145/467, 31.05%） and the third were fungi （23/467, 4.92G）. The results of drug sensitivity tests showed that all of strains had higher resistance rate. The rate of extended spectrum β-1actamases （ESBLs） and meticillin-resistant Staphylococcus （MRS） was very high. The incidence of nosocomial infection was seriously correlated with age, fatness, long smoking history, complicated diseases such as diabetes, damaged renal function and using time of mechanical ventilation over 24 hours. Conclusion The nosocomial infection of lung cancer patients after surgical treatment is seriously correlated with patient＇s age, fatness, long smoking history, complicated diseases such as diabetes, damaged renal function and using time of mechanical ventilation over 24 hours. More attentions should be paid to the pathogenic species and its correlative factors of nosocomial infection in lung cancer patients. The resistance of bacteria to the commonly used antibiotics is produced in various degrees. During clinical therapy with antibiotics, antibiotics should be selected according to the results of drug sensitivity tests. In order to reduce the production of drugresistance, the appropriate use of antibiotics must be strengthened.