肿瘤化疗患者医院感染的危险因素分析

Analysis of status and risk factors of hospital infections in tumor patients undergoing chemotherapy

目的研究肿瘤化疗患者医院感染病原菌的耐药性以及感染因素,指导控制和治疗肿瘤化疗患者医院感染。方法选取2011年3月-2012年12月进行化疗的肿瘤患者685例,记录发生感染患者的病例数;对感染患者送检标本进行分离培养病原菌;采用K-B琼脂试验检测病原菌的耐药性,并研究感染的危险因素。结果 685例肿瘤化疗患者发生医院感染75例,感染率10.95%;感染部位以呼吸道为主占53.33%,其次为消化道、泌尿道、生殖道及皮肤感染,分别占17.34%、12.00%、8.00%及5.33%;共分离出病原菌82株,其中革兰阳性菌36株占43.90%,革兰阴性菌39株占47.56%,真菌7株占8.54%;革兰阳性菌对利奈唑胺、革兰阴性菌对美罗培南、真菌对制菌霉素的耐药率均为0;肿瘤患者发生医院感染的危险因素为患者年龄大、化疗时间长、合并其他疾病、进行侵入性操作、未应用抗菌药物预防。结论肿瘤化疗患者是医院感染的高危人群,医护工作人员应采取措施控制化疗患者医院感染的发生,选用耐药率低的抗菌药物进行及时治疗。

OBJECTIVE To analyze the pathogenic bacteria and their drug resistance,and to investigate the risk factors of hospital infections in tumor patients undergoing chemotherapy so as to guide the control and treatment of hospital infections in tumor patients undergoing chemotherapy.METHODS Totally 685 tumor patients undergoing chemotherapy during Mar.2011 to Dec.2012 were chosen,the number of cases with infection was recorded.Pathogenic bacteria were isolated and cultured,and drug resistance was tested by K-B agar.Risk factors of hospital infection in tumor patients undergoing chemotherapy were investigated by comparison of factors between infection patients and un-infection patients.RESULTS The occurrence of hospital infection in tumor patients undergoing chemotherapy was 10.95%（75cases）.For infection sites,there were mainly respiratory system infections accounting for 53.33%,followed by digestive system infections accounting for 17.33%,urinary system infections accounting for 12.00%,genital system infections accounting for 8.00%,skin infections accounting for5.33%.Totally 82 strains of pathogenic bacteria were isolated,among which there were 36 strains of gram positive bacteria accounting for 43.90%,39 strains of gram negative pathogens accounting for 47.56%,7strains of fungi accounting for 8.54%.The drug resistances of gram positive bacteria to linezolid and gram negative bacteria to meropenem,and fungi to nystatin were all 0%.The risk factors of hospital infection included advanced age,long duration of chemotherapy,complication with other diseases,invasive operation and no application of prophylactic antibiotics.CONCLUSION The occurrence of hospital infections in tumor patients undergoing chemotherapy was high,medical staffs should take measures to control hospital infections in tumor patients undergoing chemotherapy,and low resistant drugs should choose to treat hospital infection.