白细胞值≤1×109/L的癌症患者预防使用抗菌药物效果分析

Prophylactic use of antibiotics for cancer inpatients with leukocyte count ≤ 1 × 109/L

目的 观察分析放化疗导致白细胞计数≤1×109/L的癌症住院患者应用抗菌药物预防感染的效果,为合理使用抗菌药物提供依据.方法 对2014年426例放化疗导致白细胞计数≤1.0×109/L的癌症住院患者进行回顾性分析,统计抗菌药物预防性使用与患者医院感染获得情况.结果 426例住院患者中,预防性使用抗菌药物的患者感染率为11.0％,未预防性使用抗菌药物的患者感染率为20.9％,差异有统计学意义（x2 =6.815,P=0.009）.发生感染的患者,白细胞计数中位值为0.73×109/L,未发生感染的患者为0.77×109/L,差异无统计学意义（Z=-1.257,P=0.209）.感染部位以下呼吸道、上呼吸道和胃肠道为主,分别占48％、12％、11％.病原菌检出前5位的细菌依次为肺炎克雷伯菌、阴沟肠杆菌、大肠埃希菌、产气肠杆菌、金黄色葡萄球菌.预防性使用抗菌药物以头孢菌素类为主.结论 放化疗致癌症住院患者白细胞计数≤1×109/L时,给予合理的预防性应用抗菌药物可降低医院感染率.

Objective To investigate the infection prevention effect of prophylactic use of antibiotics for cancer inpatients with leukocyte count ≤ 1 × 109/L.Then to provide the basis for rational use of antibiotics.Methods It was retrospectively surveyed that the infection situation and prophylactic usage of antibiotics in the 426 cancer inpatients with leukocyte count ≤ 1 × 109/L caused by radiotherapy and chemotherapy.Results In the 426 inpatients,the infection rates of patients with and without prophylactic use of antibiotics were 11.0% and 20.9% respectively.The difference was statistically significant （x2 =6.815,P =0.009）.The leukocyte count median values of patients with and without infection were 0.73 × 109/L and 0.77 × 109/L respectively.The difference had no statistical significance（Z =-1.257,P =0.209）.The main infection sites were lower respiratory tract,upper respiratory tract and gastrointestinal tract with infection rates of 48%,12% and 11%,respectively.The top five pathogens were Klebsiella pneumonia,Enterobacter cloacae,Escherichia coli,Enterobacter aerogenes and Staphylococcus aureus.The most use of antibiotics were cephalosporin.Conclusion When the leukocyte counts of cancer inpatients are less than or equal to 1 × 109/L induced by chemotherapy and radiotherapy,reasonable prophylactic use of antibiotics can reduce hospital infection rates.