食管癌放疗患者院内感染调查及相关预防措施研究

Investigation of nosocomial infection in patients with esophageal carcinoma and its preventive measures

目的调查食管癌放疗患者院内感染情况,并探讨预防感染的措施。方法回顾性分析2015年1月至2016年10月于本院行放疗的食管癌患者的临床资料。分析患者院内感染发生情况及其影响因素,制订院内感染预防措施。结果食管癌患者院内感染发生率为18.71%,以上呼吸道感染、肺部感染及泌尿系统感染患者居多。其中营养不良患者、放疗时间≥30天的患者、手术联合放疗患者及未使用抗生素的患者院内感染发生率均显著升高(P<0.05),癌症分期越高、放疗剂量越大,患者院内感染发生率显著升高(P<0.05),肿瘤细胞远处转移患者院内感染率显著高于肿瘤细胞未远处转移患者(P<0.05)。多因素Logistic回归分析显示,年龄≥60岁、放疗时间≥30天、放疗剂量≥30 Gy、癌症分期Ⅳ期、肿瘤细胞远处转移均是食管癌放疗患者发生院内感染的危险因素(P<0.05),营养状况良好、使用抗菌药物、白细胞计数≥4×10~9/L是食管癌放疗患者发生院内感染的保护因素(P<0.05)。64例感染患者检出致病菌82株,其中细菌58株(70.73%),真菌24株(29.27%),主要包括金黄色葡萄球菌、铜绿假单胞菌、肺炎克雷伯菌及白色假丝酵母菌。结论食管癌放疗患者院内感染发生率较高,影响因素众多,应及时采取干预措施,加强管理,以降低食管癌放疗患者院内感染发生率。

Objective To investigate the incidence of nosocomial infection in patients with esophageal carcinoma and to explore the measures to prevent infection. Method The clinical data of patients with esophageal carcinoma treated with radiotherapy in our hospital from January 2015 to October 2016 were retrospectively analyzed. The incidence and influence factors of infection were analyzed to establish hospital infection prevention measures. Result The nosocomial infection rate of patients with esophageal carcinoma treated with radiotherapy was 18.71%, among which patients with upper respiratory tract infection, pulmonary infection and urinary tract infection were the most. The nosocomial infection rate in patients with malnutrition, radiotherapy time ≥ 30 days, treated by surgery combined with radiotherapy, and without the use of antibiotics increased significantly（P〈0.05）. The higher the stage of cancer and the dose of radiotherapy, the higher the incidence of nosocomial infection in patients was（P〈0.05）. The infection rate of distant metastasis of tumor cells was significantly higher than that of patients without distant metastasis of tumor cells（P〈0.05）. The multivariate Logistic regression analysis showed that ≥ 60-year-old, time of radiotherapy ≥ 30 days, dose of radiotherapy ≥ 30 Gy, stage Ⅳ breast cancer, distant metastasis of tumor cells were risk factors of infection（P〈0.05）, good nutrition, the use of antibacterial drugs and white blood cells ≥ 4×10-9/L were protective factors of nosocomial infection（P〈0.05）. A total of 82 pathogens were detected in 64 infected patients, including 58 bacteria（70.73%）, and 24 fungi（29.27%）, and they were mainly Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae and Candida albicans. Conclusion The incidence of nosocomial infection in patients with esophageal carcinoma radiotherapy was high, and there were many influencing factors. Preventive interventions should be taken in time to strengthen prevention and management so as to reduce the incidence of nosocomial infections in patients with esophageal carcinoma.