恶性血液病医院感染目标性监测及感染相关危险因素研究

Nosocomial Infection in Patients with Hematological Malignancies:Targeted Monitoring and Risk Factor Analysis

目的研究恶性血液病(HM)患者医院感染(NI)的特点和危险因素,为制定医院感染控制措施提供理论依据。方法采用目标性监测方法,研究HM患者的医院感染情况,并对住院时间、化疗、白细胞总数、中性粒细胞绝对数(ANC)等14项相关危险因素进行单因素和多因素非条件Logistic回归分析。结果242例HM患者中发生NI 86例、128例次,NI发病率为35.5%,例次发病率为52.9%,多部位感染27例(31.4%),以上呼吸道、胃肠道、下呼吸道、口腔、血液感染为主,66.7%的感染发生于化疗期间和化疗结束后7 d内;住院时间和ANC是HM患者医院感染的独立危险因素。结论HM患者是医院感染的易感人群,化疗期间和化疗结束后7 d内是医院感染的高发时期,缩短化疗后ANC恢复的时间,有效降低医院感染的发生率。

OBJECTIVE To investigate the characteristics and risk factors of nosocomial infection （NI） in patients with hematological malignancies （HM）, and provide the bases for making the controlling measures of NI. METHODS Using the targeted monitoring to study NI in patients with HM, and recording 14 factors such as the time of hospitalization, chemotherapy, count of leukocyte and absolute neutrophil count（ANC） and so on. The data were analyzed with unifactorial χ2 test and multifactorial Logistic-regression analysis. RESULTS Among 242 patients with HM the prevalence of NI was 35. 5% （86/242） and the prevalence of NI time-cases was 52. 9% （128/242）. Among 86 patients of NI there were 27 patients occurred multiple sites NI （31. 4%）. The main infection sites were upper respiratory tract, gastrointestinal tract, lower respiratory tract, oral cavity and blood. 66.7% Of NI happened in the period of chemotherapy and 7 days after chemotherapy. The time of hospitalization and ANC were independent risk factors of NI in patients with HM. CONCLUSIONS The patients with HM are susceptible population of NI, and NI often occurs in the period of chemotherapy and 7 days after chemotherapy. So medical staff should strengthen monitoring, and shorten the time of patient hospitalization and of recovery of ANC to reduce the prevalence of NI efficiently.