肿瘤专科医院恶性肿瘤院内感染123例临床分析

Clinical analysis of nosocomial infection for 123 in-patients with tumors in cancer specialized hospital

目的探讨肿瘤专科医院化疗科恶性肿瘤患者院内感染的发生率、相关因素及防治对策。方法对2009年1月-2009年12月本院化疗科住院的3 316例患者中123例发生院内感染的恶性肿瘤患者的资料进行回顾性分析,包括感染部位、感染致病菌、患者年龄、肿瘤期别、住院时间等,并初步探讨院内感染的防治。结果本组院内感染率、病死率为3.8%、17.1%。感染与年龄、肿瘤期别、抗肿瘤治疗和侵袭性操作密切相关。感染主要部位是下呼吸道、泌尿道,分别占53.7%、16.3%。病原体阳性患者112例,共检出致病菌株127例,有9例为合并几种菌感染。感染主要菌种为革兰氏阴性菌占67株(52.8%),其中前3位是肺炎鲍曼不动杆菌18株(14.2%),克雷伯菌16株(12.6%),铜绿色假单胞菌14株(11.0%)。真菌36株(28.3%);革兰氏阳性菌24株(18.9%),主要是表皮葡萄球菌。结论恶性肿瘤患者院内感染常由条件致病菌引起,住院时间长、放化疗结合、老年及晚期肿瘤患者是院内感染的主要危险因素。降低院内感染,应采取综合措施。

Objective To investigate the incidence and the related factors of nosocomial infection and to explore the prevention countermeasures for in-patients with tumors in cancer specialized hospital. Methods From January 2009 to December 2009,related nosocomial infection data of 123 cases of 3 316 patients with tumors in our hospital inpatient chemotherapy were retrospectively analyzed.The analysis contents included sites of infection,bacteria infection,patient age,tumor stage,hospitalization time.The prevention of nosocomial infections was explored. Results The hospital infection rate and mortality rate were 3.8% and 17.1%.Infection,age,tumor stage,anti-cancer therapy and invasive operation were closely related.Major parts of infection were lower respiratory tract infections and urinar tract,accounting for 53.7% and 16.3%.One hundred and twenty-seven bacteric strains were checked out in 112 patients,including 9 cases with several bacterial infections.Gram-negative bacilli accounted for 52.8%（67 strains）,and among them,the top three were Baumanii′s bacteria（14.2%,18 strains）,the pneumonic Klebsiella′s germ（12.6%,16 strains） and pseudomonas aeruginnosa（11.2%,14 strains）.There were 36 fungi strains（28.3%） and 24 strains of Gram-positive-bacilli（18.9%）. Conclusions The primary risk factors of nosocomial infection are hospitalization time,combination of radiotherapy and chemotherapy,old patients and advanced stage.It is necessary to take integrative measures to depress the rate of nosocomial infection.