老年乳腺癌患者围手术期医院感染的影响因素

Risk factors and preventive measures of nosocomial infection in elderly patients with breast cancer during perioperative period

目的探讨老年乳腺癌患者围手术期医院感染的影响因素及预防对策。方法选择医院2012年1月-2017年9月收治的行乳腺癌改良根治术老年乳腺癌患者328例作为研究对象。统计分析围术期患者感染率,分离培养医院感染患者病原菌,调查统计患者的年龄、肿瘤部位、肿瘤分期、病理分型、手术时间、住院时间等临床资料,单因素及多因素Logistic回归分析医院感染的影响因素。结果 328例乳腺癌患者中围术期医院感染患者49例,感染率为14.94%。49例医院感染患者中感染部位以呼吸道为主,20例占40.82%;49例医院感染患者分离培养病原菌61株,其中革兰阴性菌34株占55.74%、革兰阳性菌21株占34.43%、真菌6株占9.84%,革兰阴性菌以铜绿假单胞菌为主,革兰阳性菌以金黄色葡萄球菌为主;多因素Logistic回归分析结果显示,年龄≥75岁、手术时间≥100min、住院时间≥14d、血清白蛋白≥35g/L、血红蛋白≥70g/L和联合放化疗为医院感染的影响因素(P<0.05)。结论老年乳腺癌患者围手术期医院感染率较高,以呼吸道和切口感染为主,病原菌以革兰阴性菌为主,医院感染受多因素影响,应做好影响因素预防措施,降低医院感染率。

OBJECTIVE To explore the risk factors and preventive measures of nosocomial infection in elderly patients with breast cancer during the perioperative period.METHODS 328 cases of elderly breast cancer patients who underwent modified radical mastectomy from Jan.2012 to Sep.2017 were selected as the research objects.The infection rate of patients in the perioperative period was determined.Pathogens were isolated and cultivated from patients with nosocomial infection.Retrospective analysis of the clinical data of patients such as age,tumor location,tumor stage,pathological types,surgery duration and length of hospitalization was conducted.The independent risk factors affecting nosocomial infection were analyzed by univariate and multivariate logistic regression analysis.RESULTS In the 328 cases of breast cancer patients,there were 49 cases of nosocomial infection during the perioperative period,with an infection rate of 14.94%.Among the 49 cases of nosocomial infection,there were 20 cases of respiratory tract infection,15 cases of incision infection,6 cases of skin and soft tissue infection,5 cases of urinary tract infection,and 3 cases of other infection.There were 61 strains of pathogens isolated from 49 cases of nosocomial infection,including 34 strains of gram-negative bacteria accounting for 55.74%,21 strains of grampositive bacteria accounting for 34.43%,and 6 strains of fungi accounting for 9.84%.The main gram-negative bacterium was Pseudomonas aeruginosa,the main gram-positive bacterium was Staphylococcus aureus.Multivariate logistic regression analysis results suggested age of≥75 years old,operation duration of≥100 min,length of hospital stay of≥14 days,serum albumin level of≥35 g/L,hemoglobin level of≥70 g/L and combined chemoradiotherapy were independent risk factors for nosocomial infection(P<0.05).CONCLUSION The incidence of nosocomial infection is higher in elderly patients with breast cancer during the perioperative period,dominated by respiratory tract infection and incision infection.Gram-negative bacteria are the main pathogens.Nosocomial infection is affected by many factors.Preventive measures should be taken to reduce the incidence of nosocomial infection.