肝恶性肿瘤患者肝动脉化疗栓塞术后继发感染病原菌及影响因素

Pathogen distribution and influencing factors for secondary infection after transcatheter arterial chemoembolization in patients with liver malignant tumor

目的 分析肝恶性肿瘤患者肝动脉化疗栓塞术(TACE)后继发感染的病原及影响因素。方法 选取2018年1月-2020年1月间南阳医学高等专科学校第一附属医院收治的43例TACE后继发感染患者作为感染组,并选取同期收治的43例TACE术后未感染者作为对照组。分析感染患者的病原菌和耐药性情况以及TACE术后感染发生的危险因素。结果 43例TACE术后继发感染者共培养分离病原菌48株,其中革兰阳性菌21株;革兰阴性菌27株;金黄色葡萄球菌对环丙沙星和左氧氟沙星耐药性较高,表皮葡萄球菌对左氧氟沙星和环丙沙星耐药性较高;大肠埃希菌、铜绿假单胞菌均对头孢唑林耐药性较高;两组年龄、手术时间、术前白蛋白水平、预防性使用抗生素时间、腹水情况差异有统计学意义(P<0.05);Logistic回归分析显示:年龄≥60岁、手术时间≥2 h、术前白蛋白<30.0 g/L、预防性使用抗生素时间<7 d、腹水均是影响TACE术后继发感染的独立危险因素(P<0.05)。结论 肝恶性肿瘤患者TACE术后继发感染的影响因素较多,规范预防性抗菌药物使用、调整术前患者身体状况对降低感染风险有利。

OBJECTIVE To analyze the etiology and influencing factors for secondary infection after hepatic arterial chemoembolization(TACE) in patients with hepatic malignant tumor. METHODS The clinical data of 43 patients with secondary infection after TACE admitted to the First Affiliated Hospital of Nanyang Medical College from Jan 2018 to Jan 2020 were retrospectively analyzed and divided into the infection group;43 patients without infection after TACE during the same period were in the control group. The pathogenic bacteria distribution and drug-resistance of the strains in the infected patients were analyzed, and the risk factors for postoperative TACE infection were analyzed. RESULTS 48 strains of pathogenic bacteria were isolated from 43 patients with secondary infection after TACE, including 21 strains of gram-positive bacteria and 27 strains of Gram-negative bacteria. Staphylococcus aureus had the highest drug-resistance to ciprofloxacin and cefazolin;Staphylococcus epidermidis had the highest drug resistance to levofloxacin and ciprofloxacin;Escherichia coli and Pseudomonas aeruginosa were highly resistant to cefazolin. There were significant differences in age, operation time, preoperative albumin level, prophylactic antibiotic use time and ascites status between the two groups(P<0.05). Multivariate Logistic regression analysis showed that age, operation time, preoperative albumin, prophylactic antibiotic use time and ascites were all independent risk factors for secondary infection after TACE(P<0.05). CONCLUSION There are many influencing factors for secondary infection after TACE in patients with hepatic malignant tumor. Standardization of prophylactic antibiotics usage and the improvement of patients′ physical condition before surgery is benefit to reduce the risk of infection.