老年胃肠道恶性肿瘤患者术后真菌感染的危险因素及耐药性分析

Analysis of risk factors and drug resistance of postoperative fungal infection in elderly patients with gastrointestinal malignant tumors

目的探讨老年胃肠道恶性肿瘤患者术后真菌感染的危险因素和耐药性。方法根据术后是否发生真菌感染将83例老年胃肠道恶性肿瘤患者分为真菌感染组(n=47)和无真菌感染组(n=36)。比较真菌感染组和无真菌感染组患者的临床特征,采用Logistic回归模型分析老年胃肠道恶性肿瘤患者术后真菌感染的危险因素。采集真菌感染组患者标本进行培养、鉴定和药敏试验,分析真菌分布情况及对抗菌药物的耐药情况。结果单因素分析结果显示,真菌感染组和无真菌感染组患者合并基础疾病情况、近期抗感染治疗情况、白细胞计数、临床分期、快速康复外科治疗情况、手术时间比较,差异均有统计学意义(P﹤0.05)。多因素Logistic回归分析结果显示,合并基础疾病、近期进行过抗感染治疗、白细胞计数﹤4.0×10^(9)/L均是老年胃肠道恶性肿瘤患者术后发生真菌感染的危险因素(P﹤0.05)。47例术后真菌感染患者标本中共检出178株真菌,其中白念珠菌最常见(122株,68.54%),其次是光滑念珠菌(25株,14.04%)。178株真菌对伊曲康唑的耐药率最高(82.02%),其次是氟康唑(77.53%);对氟胞嘧啶耐药率最低(5.62%),其次是两性霉素(6.18%)。结论合并基础疾病、近期进行过抗感染治疗、白细胞计数﹤4.0×10^(9)/L均是老年胃肠道恶性肿瘤患者术后发生真菌感染的危险因素。在抗真菌药物中,伊曲康唑和氟康唑耐药率较高,两性霉素、氟胞嘧啶耐药率较低。

Objective To explore the risk factors and drug resistance of postoperative fungal infection in elderly patients with gastrointestinal malignant tumors.Method According to the occurrence of postoperative fungal infection,83 elderly patients with gastrointestinal malignant tumors were divided into fungal infection group(n=47)and non-fungal infection group(n=36).The clinical characteristics of fungal infection group and non-fungal infection group were compared,and the risk factors of postoperative fungal infection in elderly patients with gastrointestinal malignant tumors were analyzed by Logistic regression model.Samples of patients with fungal infection were collected for culture,identifi-cation and drug sensitivity test,and the fungal distribution and antimicrobial resistance were analyzed.Result Univariate analysis showed that there were statistically significant differences in underlying diseases,recent anti-infection treatment,white blood cell count,clinical stage,rapid rehabilitation surgical treatment and operation time between fungal infection group and non-fungal infection group(P<0.05).Multivariate Logistic regression analysis showed that combined underlying diseases,recent anti-infective therapy and white blood cell count<4.0×10^(9)/L were risk factors for postoperative fungal infection in elderly patients with gastrointestinal malignant tumors(P<0.05).A total of 178 strains of fungi were detected in 47 patients with postoperative fungal infection,among which Candida albicans was the most common(122 strains,68.54%),followed by Candida glabra(25 strains,14.04%).The drug resistance rate of 178 strains to itraconazole was the highest(82.02%),followed by fluconazole(77.53%);the drug resistance rate to fluorocytosine was the lowest(5.62%),followed by amphotericin(6.18%).Conclusion Combined underlying diseases,recent anti-infective therapy and white blood cell count<4.0×10^(9)/L were risk factors for postoperative fungal infection in elderly patients with gastroin-testinal malignant tumors.Among the antifungal drugs,itraconazole and fluconazole had higher resistance rates,while amphotericin and fluorocytosine had lower resistance rates.