老年肺癌患者行胸腔镜根治术后发生医院获得性肺炎的病原学特点及危险因素研究

Etiological Characteristics and Risk Factors of Hospital Acquired Pneumonia in Elderly Patients with Lung Cancer after Thoracoscopic Radical Surgery

目的:研究老年肺癌患者行胸腔镜根治术后合并医院获得性肺炎(HAP)的病原学特点及危险因素。方法:回顾性分析广州医科大学附属肿瘤医院2019年10月-2022年10月行胸腔镜根治术的203例老年肺癌患者的临床资料,所有患者均进行痰液或呼吸道分泌物标本的细菌培养,统计分析患者术后肺部感染情况及病原菌分布情况,选择logistic回归分析其患者术后发生HAP的危险因素。结果:203例老年肺癌患者行胸腔镜根治术后发生HAP 33例,感染率16.26%。从33例感染患者中分离出病原菌91株,其中革兰阴性菌57株,构成比62.64%,主要有肺炎克雷伯菌33株,构成比57.89%,铜绿假单胞菌13株,构成比22.81%,鲍曼氏不动杆菌9株,构成比15.79%,大肠埃希菌2株,构成比3.51%;革兰阳性菌25株,构成比27.47%,主要有肺炎链球菌13株,构成比52.00%,金黄色葡萄球菌8株,构成比32.00%,粪肠球菌4株,构成比16.00%;真菌9株,构成比9.89%,主要有白假丝酵母菌7株,构成比77.78%,其他真菌2株,构成比22.22%。单因素分析结果得出,性别、切口明显疼痛、病理类型、术中出血量、病程、冠状动脉粥样硬化性心脏病及高血压与老年肺癌患者行胸腔镜根治术后发生HAP无关(P>0.05);侵入性操作、糖尿病、手术时间≥3 h、未使用抗菌药物、术后胸腔引流时间≥7 d、血清白蛋白≤30 g/L、白细胞≤1.5×109/L及慢性呼吸系统疾病与老年肺癌患者行胸腔镜根治术后发生HAP有关(P<0.05)。logistic回归分析得出,侵入性操作、糖尿病、手术时间≥3 h、未使用抗菌药物、血清白蛋白≤30 g/L、白细胞≤1.5×109/L、慢性呼吸系统疾病及术后胸腔引流时间≥7 d均是影响老年肺癌患者行胸腔镜根治术后肺部发生院内感染的独立危险因素(P<0.05)。结论:影响老年肺癌患者术后肺部发生院内感染的因素较多,其感染病原菌以革兰阴性菌为主,侵入性操作、糖尿病、手术时间≥3 h、未使用抗菌药物、血清白蛋白≤30 g/L、白细胞≤1.5×109/L、慢性呼吸系统疾病及术后胸腔引流时间≥7d均是影响老年肺癌患者行胸腔镜根治术后合并HAP的独立危险因素。

Objective:To investigate the etiological characteristics and risk factors of hospital acquired pneumonia in elderly patients with lung cancer after thoracoscopic radical surgery.Method:Retrospective analysis was performed on the clinical data of 203 elderly patients with lung cancer who underwent thoracoscopic radical surgery from October 2019 to October 2022 in Affiliated Cancer Hospital and Institute of Guangzhou Medical University.Bacterial culture was performed on sputum or respiratory secretion samples of all patients,and the postoperative pulmonary infection and pathogenic bacteria distribution were statistically analyzed.logistic regression was selected to analyze the risk factors of HAP.Result:HAP occurred in 33 of 203 elderly lung cancer patients who underwent thoracoscopic radical surgery,with an infection rate of 16.26%.Ninety-one strains of pathogenic bacteria were isolated from 33 infected patients,among them,there were 57 Gram negative bacteria,accounting for 62.64%,mainly including 33 Klebsiella pneumoniae,accounting for 57.89%,13 Pseudomonas aeruginosa,accounting for 22.81%,9 Acinetobacter baumannii,accounting for 15.79%,and 2 Escherichia coli,accounting for 3.51%.25 strains of Gram positive bacteria,accounting for 27.47%,including 13 strains of Streptococcus pneumoniae,accounting for 52.00%,8 strains of Staphylococcus aureus,accounting for 32.00%,and 4 strains of Fecal Enterococcus,accounting for 16.00%.There were 9 fungi with a composition ratio of 9.89%,mainly including 7 Candida albicans with a composition ratio of 77.78%,and 2 other fungi with a composition ratio of 22.22%.The results of univariate analysis showed that gender,obvious incision pain,pathological type,intraoperative bleeding,course of disease,coronary atherosclerotic heart disease and hypertension were not related to HAP in elderly lung cancer patients after thoracoscopic radical surgery(P>0.05).Invasive operation,diabetes,operation time≥3 h,no antibacterial drugs used,postoperative thoracic drainage time≥7 d,serum albumin≤30 g/L,white blood cells≤1.5×109/L and chronic respiratory diseases were associated with HAP in elderly lung cancer patients underwent thoracoscopic radical surgery(P<0.05).logistic regression analysis showed that invasive operation,diabetes,operation time≥3 h,no antibacterial drugs used,serum albumin≤30 g/L,white blood cells≤1.5×109/L,chronic respiratory diseases,and postoperative thoracic drainage time≥7 d were independent risk factors for nosocomial infection in elderly lung cancer patients underwent thoracoscopic radical surgery(P<0.05).Conclusion:There are many factors affecting nosocomial pulmonary in elderly patients with lung cancer after operation,and the pathogenic bacteria are mainly Gram negative bacteria.Invasive surgery,diabetes mellitus,operation time≥3 h,no antibacterial drugs used,serum albumin≤30 g/L,white blood cells≤1.5×109/L,chronic respiratory diseases and postoperative thoracic drainage time≥7 d are all independent risk factors for nososoial pulmonary in elderly patients with lung cancer after thoracoscopic radical surgery.