肝癌患者介入术后医院感染的病原学特征及危险因素分析

Analysis on the pathogenic characteristics and risk factors of nosocomial infection in patients with liver cancer after interventional therapy

目的探讨肝癌患者介入术后医院感染情况及其影响因素,为临床干预和治疗提供科学依据。方法回顾性分析2018年1月至2020年12月于石河子大学医学院第一附属医院急诊科行肝癌介入术的176例患者的临床资料,根据术后是否发生医院感染分为感染组和非感染组,对感染组的病原学特征进行描述,采用单因素分析及多因素logistic回归对感染危险因素进行分析。结果176例研究对象中有31例发生医院感染,感染率为17.61%,术后感染好发部位依次为肺部(35.48%)、胆道(25.81%)、腹腔(22.58%)、泌尿系统(16.13%)。感染组共分离出47株菌株,分别为革兰阴性菌31株(65.96%),以大肠埃希菌为主;革兰阳性菌16株(34.04%),以金黄色葡萄球菌为主。单因素分析结果显示,两组患者性别、体重指数、高血压史、吸烟史、饮酒史、肿瘤最大直径比较,差异无统计学意义(P>0.05),两组年龄、糖尿病史、白蛋白、白细胞、手术时间、术中出血量、皮肤黏膜溃损、有侵入性操作、伴有腹水、抗生素使用时间、住院时间比较,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,年龄≥60岁、有糖尿病史、白蛋白<30 g/L、白细胞<2.5×10^(9)/L、手术时间≥2 h、术中出血量≥500 ml、伴有皮肤黏膜溃损、伴有腹水、有侵入性操作、抗生素使用时间≥7 d、住院时间≥21 d为肝癌介入术后患者医院感染的独立危险因素(P<0.05)。结论肝癌介入术后医院感染率较高,以肺部感染较为多见,感染菌种以革兰阴性菌感染为主。肝癌患者介入术后医院感染危险因素多且复杂,应根据术后感染特征及感染高危因素进行针对性防控。

Objective To investigate the nosocomial infection and its impacting factors in patients with liver cancer after interventional therapy,so as to provide scientific basis for clinical intervention and treatment.Methods The clinical data of 176 patients with liver cancer after interventional therapy admitted to the Department of Emergency of the First Affiliated Hospital of School of Medicine of Shihezi University from January 2018 to December 2020 were retrospectively analyzed.According to whether there was infection after operation,they were divided into the infection group and the non-infection group.The pathogenic characteristics of the infection group were described,and the risk factors of infection were analyzed by univariate analysis and multivariate logistic regression.Results In the 176 subjects,there was nosocomial infection in 31 cases,with an infection rate of 17.61%.The commonest sites of postoperative infection in sequence were lung(35.48%),biliary tract(25.81%),abdominal cavity(22.58%)and urinary system(16.13%).A total of 47 strains were isolated from the infection group,including 31 strains of Gram-negative bacteria(65.96%),mainly Escherichia coli,and 16 strains of Gram-positive bacteria(34.04%),mainly Staphylococcus aureus.Univariate analysis showed that there were no statistically significant differences in gender,BMI,hypertension history,smoking and drinking history and the maximum diameter of tumor between the two groups of patients(P>0.05).There were statistically significant differences in age,diabetes history,ALB,WBC,operation time,intraoperative hemorrhage volume,skin and mucous membrane ulceration,invasive operation,ascites,antibiotic use time and hospitalization time,etc.(P<0.05).Multivariate logistic regression analysis showed that age≥60 years,history of diabetes,ALB<30 g/L,WBC<2.5×10^(9)/L,operation time≥2 h,intraoperative hemorrhage volume≥500 ml,skin and mucous membrane ulceration,ascites,invasive operation,antibiotic use time≥7 d and hospitalization time≥21 d can be regarded as independent risk factors of postoperative nosocomial infections.Conclusion The nosocomial infection rate after interventional therapy for liver cancer is relatively high,and pulmonary infection is especially commoner.The main infectious bacteria are Gram-negative bacteria.There are numerous and complicated risk factors of nosocomial infection in patients with liver cancer after interventional therapy,so targeted prevention and control shall be carried out according to the characteristics of postoperative infection and high-risk factors of infection.