同步放化疗治疗局部晚期鼻咽癌并医院感染的临床分析

Nosocomial infection during chemoradiotherapy for advanced nasopharyngeal carcinoma:a clinical investigation

目的调查分析局部晚期鼻咽癌行同步放化疗患者医院感染情况,探讨有效的防治措施。方法回顾性分析55例行同步放化疗鼻咽癌住院患者的医院感染病原体及药物敏感试验。结果 55例患者中发生医院感染38例,感染率为69.01%;医院感染出现的时间为放疗开始后10～49 d,中位时间为29.5 d;感染部位为口咽及鼻咽部黏膜36例,占94.73%,肺部1例,占2.63%,败血症1例,占2.63%;共分离病原菌47株及带状疱疹病毒1株,以革兰阴性菌最多见,共27株,占56.25%,其次为真菌,共18株,占37.50%;革兰阳性菌2株,占4.17%;革兰阴性菌耐药现象多见,主要对青霉素类、第一二代头孢类抗菌药物耐药;医院感染高危因素为口咽黏膜炎、白细胞减少、激素不合理使用。结论同期放化疗医院感染以革兰阴性菌口咽黏膜感染发生率最高,重视咽拭子培养及药敏检测,加强口腔护理、预防白细胞下降、合理应用糖皮质激素。

OBJECTIVE To investigate the risk factors of nosocomial infection in patients with advanced nasopharyngeal cancer during chemoradiotherapy. METHODS Fifty five cases of advanced nasopharyngeal cancer patients in our hospital were analyzed retrospectively. RESULTS 38 inpatients oecured nosocomial infection. The infection rate was 69.01% and isolates of bacteria were found, of which Gram-negative organisms were 56.25 %, epiphyte were 37.50%, Gram-positive ones were 4. 17%. The drug susceptibility reports showed that Gram- negative organisms were high drug resistance to penicillins, the first generation cephalosporins and the second generation cephalosporins. The main risk factors were oropharynx mucosal lesion, leukocytopenia, improper application of glucocorticoids. CONCLUSION It is Gram-negative bacteria oropharyngeal mucosal which is the highest rate of nosocomial infection in patients with advanced nasopharyngeal cancer during chemoradiotherapy. It is very important for us to test throat swab cultures and antimicrobial resistance. To prevent and control nosoeomial infection in advanced nasopharyngeal cancer during chemoradiotherapy, measures such as reinforcing oral nursing, preventing the leukocytopenia, reasonable using of glucocorticoids should be adopted.