血液肿瘤患者医院感染病原菌特点及危险因素分析

Characteristics and risk factors of nosocomial infection pathogens in patients with hematological malignancies

目的 了解血液肿瘤住院患者医院感染特点,研究病原菌分布及其耐药性,分析危险因素。方法 回顾性分析2019年1月—2020年12月在某院西院区血液肿瘤患者的临床资料,对血液肿瘤患者医院感染发生情况、病原菌分布、耐药性及相关危险因素进行统计分析。结果 共调查血液肿瘤患者4 070例,发生医院感染423例次,感染率为10.39%;感染部位以呼吸道、血液系统和皮肤软组织为主,分别占35.46%、28.61%和15.84%;共分离病原菌95株,革兰阴性菌占69.47%,分离的病原菌对氨苄西林、头孢唑林、青霉素G等抗菌药物耐药率较高;多因素分析显示住院时间增加、低白细胞数、中性粒细胞缺乏、使用糖皮质激素、中心静脉置管和化疗均为血液肿瘤患者医院感染发生的独立危险因素。结论 血液肿瘤住院患者医院感染率高,感染部位以呼吸道和血液系统为主,病原菌以革兰阴性菌为主,耐药性严重,应针对独立危险因素制订有效的防控措施。

Objective To understand the characteristics of nosocomial infection and the distribution drug resistance of pathogenic bacteria, so as to analyze the risk factors in hospitalized patients with hematological malignancies.Methods Retrospective analysis was used to analyze the clinical data with hematological malignancies in the western hospital of a hospital from January 2019 to December 2020, and the occurrence of hospital infection, pathogenic bacteria distribution, drug resistance analysis and risk factors of patients were statistically analyzed.Results A total of 4070 patients with hematological malignancies were investigated.There were 423 cases of nosocomial infection, and the infection rate was 10.39%.The main infection sites were respiratory tract, blood system, and skin and soft tissuet, with percent of 35.46%,28.61% and 15.84%,respectively. A total of 95 strains of pathogenic bacteria were isolated, of which 69.47% were Gram-negative bacteria. The isolated pathogens had a high resistance rate to ampicillin, cefazolin and penicillin G. Multivariate Logistic regression analysis indicated that increased hospitalization time, low white blood cell count, neutrophil deficiency, glucocorticoid use, central venous catheterization and chemotherapy were the independent risk factors of nosocomial infections in patients with hematological malignancies.Conclusion The nosocomial infection rate of hospitalized patients with hematological tumors is high, and the infection sites are mainly respiratory tract and blood system infection. The pathogenic bacterias are mainly Gram-negative bacteria, and the drug resistance is serious. Effective prevention and control measures should be formulated for independent risk factors.