晚期肺癌化疗患者发生医院感染的病原菌分布及危险因素分析

Pathogenic Bacteria Distribution and Risk Factors of Nosocomial Infections in Advanced Lung Cancer Patients Underwent Chemotherapy

目的:研究晚期肺癌化疗患者发生医院感染的病原菌分布及危险因素,为临床预防及降低医院感染提供参考。方法:选择从2012年9月-2015年9月在我院接受化疗治疗的晚期肺癌患者235例进行研究。调查并统计所有患者的病历资料,对感染者的鼻拭子、痰标本及腹水等标本进行细菌鉴定及药敏试验,分析晚期肺癌化疗患者发生医院感染的危险因素。结果:235例晚期肺癌化疗患者中,发生医院感染65例,感染率为27.66%,共检出病原菌75株,其中革兰阴性菌41株,占54.67%,革兰阳性菌26株,占34.67%,真菌8株,占10.67%。肺炎克雷伯菌对氨苄西林的耐药率最高,为80.00%,对万古霉素的敏感率最高,为100.00%;金黄色葡萄球菌对青霉素的耐药率最高,为94.74%,对利奈唑胺的敏感率最高,为100.00%。根据Logistic回归分析法评价可知,晚期肺癌化疗患者发生医院感染的危险因素主要有:年龄≥60岁、临床分期为Ⅳ期、接受放疗、存在贫血、使用抗生素以及住院时间≥15d。结论:导致晚期肺癌化疗患者发生医院感染的主要病原菌为肺炎克雷伯菌以及金黄色葡萄球菌,且年龄≥60岁、临床分期为Ⅳ期、接受放疗、存在贫血、使用抗生素以及住院时间≥15d均为影响晚期肺癌化疗患者发生医院感染的危险因素,值得临床重视。

Objective： To study the pathogenic bacteria distribution and risk factors of nosocomial infections in advanced lung cancer patients underwent chemotherapy,so as to provide the reference for clinical prevention and reduction of nosocomial infections.Methods： A total of 235 patients with advanced lung cancer who were underwent chemotherapy in our hospital from September 2012 to September 2015 were selected for the research, the clinical data were investigated and analyzed,and the bacteria identification and drug sensitivity test were carried out on nasal swab, sputum specimen and ascites, etc. The risk factors of nosocomial infection in patients with advanced lung cancer underwent chemotherapy were analyzed. Results： In those 235 patients, 65 patients occurred nosocomial infection,the infection rate was 27.66%, 75 strains of pathogenic bacteria were detected, including 41 strains of gram negative bacteria, accounting for 54.67%, 26 strains of gram positive bacteria, accounting for 34.67%, and 8 strains of fungi, accounting for 10.67%. Drug resistance rate of Klebsiella pneumoniae to ampicillin was highest to 80.00%, and the sensitive rate to vancomycin was highest to 100.00%; Drug resistance rate of Staphylococcus aureus to penicillin was highest to 94.74%, and the sensitive rate to linezolid was highest to 100.00%.Logistic regression analysis showed that, the mainly risk factors of nosocomial infection in patients with advanced lung cancer underwent chemotherapy were： age≥60 years old and clinical stage IV, radiotherapy, anemia, using antibiotics and hospitalization time ≥15 days.Conclusion： The main pathogenic bacterias causing nosocomial infection in patients with advanced lung cancer underwent chemotherapy were Klebsiella pneumoniae and Staphylococcus aureus, and age ≥60 years old and clinical stage IV, radiotherapy,anemia,using antibiotics and hospitalization time≥15 days were its risk factors, which should pay attention in clinical practice.