华南地区某综合医院肿瘤内科医院感染的回顾性队列研究

A retrospective cohort study of hospital-acquired infection within 3 years at the department of medical oncology of a general hospital in South China

目的探讨肿瘤内科患者合并医院感染的现状。方法纳入深圳市人民医院肿瘤内科2019~2021年住院患者13938人次,采用回顾性队列研究方法,利用院内感染监控系统、住院病历及检验系统,收集医院感染患者的感染部位、病原,所有患者的一般情况、并发症等信息。结果13938例患者中,合并医院感染142例次,占总体患者的1.02%。其中不明原发灶恶性肿瘤(25.00%)、肉瘤(13.33%)、胰腺及十二指肠壶腹部癌(11.71%)患者医院感染率较高。63例患者有阳性微生物学检验结果,包括革兰阳性菌33例、革兰阴性菌28例、真菌6例、病毒1例。大肠埃希菌(15例)是检出最多的病原菌。最常见的医院感染部位为上、下呼吸道(55例,38.74%)、血流及导管相关感染(27例,19.01%)。结论我院肿瘤内科医院感染发生率与国内部分研究类似。医院感染患者的住院期间合并症及死亡率显著高于无感染患者,因此对于医院感染的预防及诊治十分重要。

Objective To elucidate the status quo of hospital-acquired infection(HAI)at department of medical oncology in recent years.Methods A retrospective,longitudinal cohort study in Shenzhen People′s Hospital between January 1,2019 and 31,December 2021 was conducted.A total of 13938 inpatients were included.The study was performed by using HAI monitoring system and inpatient documentary system.Infection site,pathogen of HAI and general condition as well as complication of all patients were collected.Results There were 142 patients with documented HAI,accounting of 1.02%of the total subjects.Among the 142 patients,patients with unknown primary malignant tumors(25.00%),sarcoma(13.33%),and cancers of the ampulla of the pancreas and duodenum(11.71%)had higher rates of HAI.There were 63 cases with positive pathogen test results,including 33 with Gram-positive bacteria,28 with Gram-negative bacteria,6 with fungi and 1 with virus.Escherichia coli(15 cases)were the most commonly detected pathogen.Upper and lower-respiratory tract(n=55 cases,38.74%),and blood flow and catheter-related infection(n=27,19.01%)were the most common sites of HAI.Hypoproteinemia,neutrophil,chronic systemic disease,invasive operation,mechanical ventilation,and hospital stay≥14 days were the risk factors for hospital-acquired infection in cancer patients.Conclusions The incidence of HAI at department of medical oncology in our hospital is similar to that in some other domestic studies.The complication rate and mortality of patients with HAI are significantly higher than those without infection.Therefore,prevention and treatment of HAI is very important.