综合预防措施对血液肿瘤病人化疗后感染情况的影响

Effect of comprehensive preventive measures on postchemotherapy infections in hematological tumor patients

目的 观察并分析血液肿瘤病人化疗后医院感染的特点,并探讨综合性预防措施控制医院感染的效果。方法 调查2018年10月至2021年9月安徽理工大学第一附属医院血液内科住院且接受化疗后的所有血液肿瘤病人,共纳入152例进行研究。回顾性分析他们的性别、年龄、基础疾病、疾病种类、住院时间、是否发生医院感染、是否采取本研究设计的预防感染的综合措施等。将使用预防措施的病人定义为综合预防措施组(综合组,82例),未使用的病人定义为非综合预防措施组(非综合组,70例),比较两组医院感染的发病率、抗生素使用情况、住院日及住院费用等指标的差异。结果 综合组和非综合组在性别、年龄、疾病种类等方面差异无统计学意义(P>0.05)。综合组医院感染的发病率为21.95%,显著低于非综合组的47.14%(P=0.002);综合组的住院日为(15.90±7.47)d,低于非综合组的(18.90±9.33)d(P=0.029);综合组的住院费用(24 520.99±14447.73)元,低于非综合组的(27 695.07±20 085.61)元(P=0.030),均差异有统计学意义。单因素分析显示年龄>65岁、髓系肿瘤、合并糖尿病、未采取综合措施、初次化疗、住院时间>20 d是发生医院感染的危险因素(P<0.05)。其中初次化疗的病人发生医院感染的比例68.63%明显高于维持性化疗的病人的31.37%(P=0.002),髓系肿瘤病人化疗后发生医院感染的比例64.71%明显高于非髓系肿瘤的35.29%(P=0.010)。多元非条件logistic多因素分析显示年龄>65岁、髓系肿瘤、住院时间≥20 d、未采取综合预防措施是医院感染发生的独立危险因素(P<0.05)。其中未采取预防措施比采取预防措施危险性增加2.61倍。结论血液肿瘤病人化疗后发生的医院感染有别于其他疾病病人,不同类型的血液肿瘤也有所区别,应该特别重视髓系肿瘤的医院感染预防。综合预防措施可以减少化疗后感染的发生率。

Objective To observe and analyze the characteristics of hospital-acquired infections after chemotherapy in hematologic tumor patients and to explore the effect of comprehensive preventive measures to control hospital-acquired infections.Methods A total of 152 hematologic tumor patients who were hospitalized in the Department of Hematology of the First Affiliated Anhui University of Science and Technology and received chemotherapy from October 2018 to September 2021 were investigated and included in the study.A retrospective analysis of their gender,age,underlying disease,type of disease,duration of hospitalization,whether they had hospitalacquired infections,and whether they took the comprehensive measures for infection prevention designed for this study was performed.The patients who used prophylaxis were defined as the combined prophylaxis group(combined group,82 cases),and those who did not use prophylaxis were defined as the noncombined prophylaxis group(noncombined group,70 cases).The differences in the incidence of hospital-acquired infections,antibiotic use,hospital days and hospital costs between the two groups were compared.Results There was no statistically significant difference between the comprehensive and noncomprehensive groups in terms of gender,age,and type of disease(P>0.05).The incidence of hospital infection in the comprehensive group was 21.95%,which was significantly lower than that in the non-comprehensive group(47.14%)(P=0.002).The hospital stay in the combined group was(15.90±7.47)d,which was lower than(18.90±9.33)d in the noncombined group(P=0.029);the cost of hospitalization in the combined group(24,520.99±14,447.73)yuan was lower than(27,695.07±20,085.61)yuan in the noncombined group(P=0.030),all of which were statistically significant differences.Univariate analysis showed that age>65 years,myeloid tumors,combined diabetes,failure to take comprehensive preventive measures,initial chemotherapy,and hospital stay>20 days were risk factors for the development of hospital-acquired infection(P<0.05).The rate of hospital infection was significantly higher in patients with initial chemotherapy(68.63%)than in patients with maintenance chemotherapy(31.37%)(P=0.002),and the rate of hospital infection after chemotherapy was significantly higher in patients with myeloid tumors(64.71%)than those with nonmyeloid tumors(35.29%)(P=0.010).Multivariate unconditional logistic analysis showed that age>65 years,myeloid tumors,hospital stay≥20 d,and failure to take comprehensive precautions were independent risk factors for the occurrence of hospital-acquired infections(P<0.05).Among them,failure to take prophylaxis was 2.61-fold more dangerous than taking prophylaxis.Conclusions Hospital-acquired infections occurring after chemotherapy in hematologic tumor patients are different from those in patients with other diseases,and different types of hematologic tumors also differ,so special attention should be given to the prevention of hospital-acquired infections in myeloid tumors.Comprehensive preventive measures can reduce the incidence of postchemotherapy infections.