血液肿瘤化疗患者医院感染病原菌分布及影响因素分析

Distribution and risk factors of nosocomial infection in patients with hematological tumor chemotherapy

目的探讨分析血液肿瘤化疗患者医院感染病原菌分布及其危险因素。方法回顾性分析2014年3月-2017年3月医院血液肿瘤化疗689例患者性别、年龄、体重指数、并发症、住院天数、化疗时间、侵入性操作、白细胞及血小板计数、免疫调节剂及激素使用情况等临床资料,调查患者医院感染发生情况,并运用多因素Logistic回归分析医院感染发生的危险因素。结果 689例血液恶性肿瘤化疗患者中,发生医院感染患者171例,医院感染发生率为24.82%;感染患者以呼吸道感染为主,97例占56.73%;171例感染患者中,共分离出病原菌158株,其中革兰阴性菌74株,占46.84%,革兰阳性菌23株,占14.56%,真菌61株,占38.61%;多因素Logistic回归分析结果显示,中性粒细胞缺乏持续时间(≥2周)、化疗时间(≥7d)、白细胞计数(<10×109/L)、合并其他疾病、侵入性操作为医院感染的影响因素(P<0.05)。结论血液肿瘤化疗患者医院感染发生率较高,是医院感染的高发人群,在化疗过程中,应密切关注侵入性操作患者切口及临床症状,并长期监测中性粒细胞及白细胞水平,以早期筛查医院感染,改善患者生存质量。

OBJECTIVE To explore the distribution and risk factors of nosocomial infection in patients with hematological tumor chemotherapy. METHODS The clinical data of 689 cases of hematological malignancies in our hospital from Mar. 2014 to Mar. 2017 were retrospectively analyzed, including gender, age, body mass index, complications, hospitalization days, chemotherapy time, invasive operation, white blood cell and platelet count, immunomodulator and hormone use. The incidence of nosocomial infections was investigated, and multivariate Logistic regression was used to analyze the risk factors of nosocomial infection. RESULTS Among the 689 patients with malignant hematological malignancies, 171 cases of nosocomial infection occurred, and the incidence of nosocomial infection was 24.82%. Of the 171 cases of infection, 97 cases were respiratory infection, accounting for 56.73%. From the 171 infected patients, 158 strains of pathogens were isolated, including 74 strains of gram-negative bacteria (46.84%), 23 strains of gram-positive bacteria (14.56%), and 61 strains of fungi (38.61%). Multivariate logistic regression analysis showed that duration of neutrophil deficiency (≥2 weeks), time of chemotherapy (≥ 7 d), white blood cell count (<10 × 10^9/L), complications with other diseases and invasive operation were risk factors for nosocomial infection (P<0.05). CONCLUSION The incidence of nosocomial infection in patients with hematological neoplasms undergoing chemotherapy is high, which is a high-risk group of nosocomial infection.In the course of chemotherapy, we should pay close attention to the incision and clinical symptoms of patients with invasive operation, and monitor the levels of neutrophils and leukocytes for a long time in order to screen for nosocomial infection early and improve the quality of life of patients.