肿瘤患者院内感染病原学分析

Analysis of the etiology of nosocomial infections in patients with tumors

目的分析肿瘤患者院内感染病原学特征,指导临床治疗。 方法收集1 029例肿瘤患者临床资料,分离鉴定患者感染病原菌类型,对主要病原菌进行耐药性分析,同时检测表皮葡萄球菌的黏附基因分布情况。 结果1 029例肿瘤患者,341例发生感染,分离出277株病原菌,革兰阳性菌130株,革兰阴性菌102株,真菌45株。表皮葡萄球菌、金黄色葡萄球菌、溶血葡萄球菌、其他各68、32、18和12株;革兰阴性菌中,阴沟肠杆菌、大肠埃希菌、肺炎克雷伯菌、其他各51、30、12和9株;真菌中,白色假丝酵母菌19株、热带假丝酵母菌14株、光滑假丝酵母菌12株。68株表皮葡萄球菌对氯霉素、青霉素、红霉素耐药率分别为64.71%、52.94%和45.59%,对万古霉素、利奈唑胺敏感。51株阴沟肠杆菌对阿莫西林、哌拉西林、环丙沙星、庆大霉素、阿米卡星的耐药率分别为39.22%、35.29%、27.45%、21.57%和17.65%。19株白色假丝酵母菌对氟康唑、益康唑、酮康唑、氟胞嘧啶、两性霉素的耐药率分别为10.53%、47.37%、21.05%、5.26%和5.26%。mecA、icaA、icaD基因的检出率分别为64.71%、20.59%和11.76%。春季、夏季、秋季、冬季的患者感染率分别为32.81%、49.76%、28.27%和23.85%,差异有统计学意义(χ2=33.1060,P<0.05)。住院时间<10d、≥10d、≥20d、≥30d、≥40d的患者感染率分别为11.95%、20.69%、38.94%、46.84%和62.84%,差异有统计学意义(χ2=68.8127,P<0.05)。肿瘤分期为I期、II期、III期、IV期的患者感染率分别为21.71%、29.77%、37.66%和54.65%,差异有统计学意义(χ2=43.1341,P<0.05)。 结论表皮葡萄球菌是肿瘤患者院内感染的主要病原菌,菌株黏附基因检出情况与表皮葡萄球菌耐药性发展关系密切,夏季、IV期肿瘤患者、长住院时间是院内感染发生的主要影响因素。

Objective To analyze the etiology of nosocomial infections in patients with tumors in order to guide clinical treatment. Methods Clinical data on 1 029patients with tumors were collected,and the types of pathogens infecting patients were identified.The drug resistance of predominant pathogens was analyzed,and the distribution of adhesion genes in Staphylococcus epidermidis was determined.The factors affecting the incidence of infection were statistically analyzed. Results Of 1 029patients with tumors,341had an infection.Two hundred and seventy-seven strains of pathogens were isolated,including 130strains of Gram-positive bacteria,102strains of Gram-negative bacteria,and 45strains of fungi.The Gram-positive bacteria included 68strains of S.epidermidis,32strains of S.aureus,18strains of S.haemolyticus, and 12strains of other Gram-positive bacteria.The Gram-negative bacteria included 51strains of Enterobacter cloacae,30strains of Escherichia coli,12strains of Klebsiella pneumoniae,and 9strains of other Gram-negative bacteria. The fungi included 19strains of Candida albicans,14strains of C.tropicalis,and 12strains of C.glabrata.Sixtyeight strains of S.epidermidis were resistant to chloramphenicol at a rate of 64.71%,to penicillin at a rate of 52.94%, and to erythromycin at a rate of 45.59%.Strains were sensitive to vancomycin and linezolid.Fifty-one strains of Enterobacter cloacae were resistant to amoxicillin at a rate of 39.22%,to piperacillin at a rate of 35.29%,to ciprofloxacin at a rate of 27.45%,to gentamicin at a rate of 21.57%,and to amikacin at a rate of 17.65%.Nineteen strains of Candida albicans were resistant to fluconazole at a rate of 10.53%,to econazole at a rate of 47.37%,to ketoconazole at a rate of 21.05%,to fluorouracil at a rate of 5.26%,and to amphotericin at a rate of 5.26%.The mecA gene was detected at a rate of 64.71%,the icaA gene was detected at a rate of 20.59%,and the icaD gene was detected at a rate of 11.76%. The rate of infection was 32.81%in the spring,49.76%in the summer,28.27%in the autumn,and 23.85%in the winter;the rate of infection differed significantly(χ2=33.1060,P=0.0000).The rate of infection was 11.95%in patients hospitalized for<10d,20.69%in patients hospitalized for≥10d,38.94%in patients hospitalized for≥20d, 46.84%in patients hospitalized for≥30d,and 62.84%in patients hospitalized for≥40d;the rate of infection differed significantly(χ2=68.8127,P=0.0000).The rate of infection was 21.71%in patients with a stage I tumor,29.77%in patients with a stage II tumor,37.66%in patients with a stage III tumor,and 54.65%in patients with a stage IV tumor;the rate of infection differed significantly(χ2=43.1341,P=0.0000). Conclusion S.epidermidis is the main pathogen causing a nosocomial infection in patients with tumors,and the detection of adhesion genes of S.epidermidisis closely related to its development of drug resistance.The main factors influencing development of a nosocomial infection were summertime,having a stage IV tumor,and a long duration of hospitalization.