恶性肿瘤患者多重耐药菌医院感染的调查

Survey of multi-drug resistant bacterial hospital infection in patients with malignant tumor

目的调查恶性肿瘤患者多重耐药菌医院感染的情况,为临床合理用药,降低和控制多重耐药菌感染提供依据。方法采用回顾性调查方法,对克拉玛依市中心医院2007年1月—2010年12月收治恶性肿瘤患者的医院感染情况进行调查,筛选出多重耐药菌感染者,并分析结果。结果该院调查期间收治恶性肿瘤患者2 937例,发生医院感染269例,其中发生多重耐药菌感染的恶性肿瘤患者44例,占恶性肿瘤患者医院感染的16.4%,所患肿瘤主要以肺癌为主,感染以肺炎为主,占43.2%;分离出多重耐药株61株,其中革兰阴性杆菌42株,革兰阳性球菌19株,排在前5位的细菌依次为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、凝固酶阴性葡萄球菌和金葡菌。所分离细菌对常用抗菌药物有很高耐药性;由多重耐药菌感染导致的病死率达65.9%。结论恶性肿瘤患者多重耐药菌感染情况严峻,控制感染发生的关键在于加强高危人群的监控和病原菌耐药性监测,减少抗菌药物不合理应用。

Objective To survey the multi-drug resistant bacterial hospital infections in the patients with malignant tumor so as to support rational use of antibiotics in clinical practice and control of multi-drug resistant infections. Methods The clinical data of nosocomial infections were reviewed retrospectively in the patients with malignant tumor treated in our hospital from January 2007 to December 2010. Multi-drug resistant bacterial infections were identified for further analysis. Results A total of 2 937 patients with malignant tumor were surveyed. Nosocomial infection was found in 269 patients. Multi-drug resistant bacterial infection was identified in 44 patients （16.4%, 44/269）. Most of the patients had lung cancer. The infection was mainly pneumonia （43.2 %）. A total of 61 multi drug resistant bacterial strains were isolated, including gram-negative bacillus （42 strains） and gram-positive coccus （19 strains）. The top five bacterial pathogens were E. coli, K. pneurnoniae, P. aeruginosa, eoagu- lase-negative Staphylococcus, and Staphylococcus aureus. These isolates were highly resistant to the commonly used antimicro bial agents. The mortality due to multi-drug resistant infection was 65.9%. Conclusions The multi-drug resistant bacterial hospi- tal infection is serious in the patients with malignant tumor. The key to control of multi-drug resistant bacterial infection is to strengthen monitoring of the patients at risk and antibiotic resistance, and reduce the unreasonable antibiotic use as far as possible.