恶性肿瘤患者医院内下呼吸道感染临床分析

Clinical Analysis of Lower Respiratory Tract Infection in Patients with Malignant Tumor

目的探讨医院内恶性肿瘤患者的下呼吸道感染病原菌谱、药物敏感性及主要危险因素。方法对我科住院的恶性肿瘤患者下呼吸道感染作一回顾性分析。结果以食管癌和肺癌放化疗后医院下呼吸道感染发生率较高;在获得的54株致病菌中,革兰阴性杆菌38株,以铜绿假单孢菌、肺炎克雷伯菌为主;革兰阳性球菌12株,以金黄色葡萄球菌、表皮葡萄球菌为主;真菌4株,药敏显示耐药现象严重。肿瘤分期晚、高龄、白细胞低下、气管插管或气管切开机械通气、昏迷、使用广谱抗生素等的患者与医院下呼吸道感染密切相关。结论下呼吸道感染以革兰阴性杆菌感染为主,为减少下呼吸道感染的发生率,对白细胞减少者进行保护性隔离,合理使用抗生素,严格无菌操作,并加强对放化疗的扶正支持治疗。

Objective To investigate the risk factor of lower respiratory tract infection in inpatients with malignant tumor, and the bacterial spectrum and drug susceptibility, Methods A retrospective analysis of lower respiratory infections in inpatients with malignant tumor was performed, Results 54 strains of pathogenic bacteria were isolated from patients＇ sputum, 38 strains were gram-negative bacilli （GNB）, most of them were Pseudomonas aeruginosa, Klebsiella pneumoniae; 12 strains were gram-positive cocci （GPC）, most of them were Staphytococcus aureus, Staphylococcus epidermidis; 4 strains were fungus. Leukocytopenia, tracheal intubation, tracheotomy, mechanical ventilation and exanimation were the most common associated risk factor with hospital-acquired lower respiratory infection. Conclusions Gram negative bacillus were the major pathogens causing lower respiratory infection, the nosocomial infection and mortality can be decreased in patients with leucopemia by isolating patients, using antibiotics reasonably, strict aseptic procedures and strengthening support treatment in patients with radiotherapy and chemotherapy.