胃癌患者术后真菌感染的临床分析

Clinical research of postoperative fungal infections in patients with gastric cancer

目的分析胃癌患者术后真菌感染的菌株分布、菌株耐药性和相关危险因素,为临床提供更好的预防及治疗胃癌术后真菌感染的策略。方法回顾性分析2013年1月至2014年12月武警后勤学院附属医院收治的256例胃癌患者手术资料及术后送检标本,分析术后真菌感染的菌株分布和耐药性,并对真菌感染的可能危险因素采用单因素和多因素Logistic回归分析。结果 256例胃癌患者术后真菌感染率为40.23%（103/256）,共检出139株菌株,其中以白假丝酵母菌感染为主,占66.91%（93/139）。真菌药敏试验结果显示,真菌对两性霉素B和5-氟胞嘧啶敏感性较高,对三唑类抗真菌药敏感性较低。患者的年龄、术前吸烟史、胃癌的TNM分期（T：代表原发肿瘤的范围,N：代表区域淋巴结转移的存在与否及范围,M：代表远处转移的存在与否）、术前使用抗菌药物、术中使用电刀、术后细菌感染和术后住院时间是胃癌术后发生真菌感染的危险因素。多因素Logistic回归分析结果显示,年龄≥60岁、术前有吸烟史、TNM分期Ⅲ~Ⅳ期、术中使用电刀以及术后细菌感染是引起胃癌术后患者发生真菌感染的独立危险因素（P均〈0.05）。结论胃癌术后真菌感染的发生率较高,且有多种危险因素与之相关,临床工作中应该有针对性的进行预防并选择敏感性高的抗真菌药。

Objective To investigate the distribution, drug resistance and the risk factors of postoperative fungal infections in patients with gastric cancer, and to provide better clinical strategy in prevention and treatment. Methods The operation data and postoperative specimens of 256 patients with gastric cancer were analyzed, retrospectively, from January 2013 to December 2014 in Affiliated Hospital of the Armed Police Logistics College. The distribution and drug resistance of postoperative fungal infections were examined respectively. The univariate and multivariate logistic regression analysis were adopted to discuss the risk factors of postoperative fungal infections. Results The postoperative fungal infections occurred in 103 among the 256 cases with gastric cancer, with the infection rate of 40.23%. Total of 139 strains of pathogenic bacteria were isolated, Candida albicans were isolated the most frequently, accounting for 66.91%. Anti-fungal susceptibility test showed that fungi were highly sensitive to amphotericin B and 5-fluorocytosine, but lower to triazole antifungal. Age, preoperative smoking history, tumor node metastasis（TNM） staging of gastric cancer patients, antimicrobial drugs before surgery, intraoperative use of electric knife, postoperative length of stay and postoperative bacterial infection were the risk factors for fungal infections after surgery. Multivariate logistic regression analysis showed that the patients with 60 years old or older, preoperative history of smoking, TNM stage at Ⅲ-Ⅳ stage, intraoperative use of electric knife and postoperative bacterial infection were independent risk factors for fungal infections after surgery（P all 〈 0.05）. Conclusions The incidence of postoperative fungal infections in patients with gastric cancer was highly relative with multiple risk factors. It is necessary to take effective preventive measures and select active antifungal drug for the patients with infections in clinical treatment.