消化道肿瘤患者化疗后骨髓抑制期感染特点及危险因素分析

Characteristics of and risk factors for infections during periods of myelosuppression in patients with gastrointestinal cancer after chemotherapy

目的探讨消化道肿瘤患者化疗后骨髓抑制期的感染部位和病原菌分布特点,并分析相关危险因素。方法选取2015年9月至2018年9月间湖北省黄冈市中心医院收治的的523例消化道肿瘤患者,按化疗后是否感染分为感染组67例和非感染组456例。观察感染组患者感染部位以及病原菌分布特点,并对两组患者进行单因素分析和多因素回归分析。结果 532例患者中发生感染的有67例,感染率为12. 8%,其中主要感染部位在呼吸系统、泌尿系统及皮肤和消化道。67例消化道肿瘤化疗后感染患者共检出病原菌46株,检出率为68. 7%,其中主要以革兰氏阴性菌为主,占比58. 7%,革兰氏阳性菌占比23. 9%,真菌占比17. 4%。革兰氏阴性菌以铜绿假单胞菌和肺炎克雷伯菌为主,革兰氏阳性菌以金黄色葡萄球菌为主,真菌以假丝酵母菌为主。年龄、并发症、不规范操作和血清白蛋白均是影响消化道肿瘤患者化疗后发生骨髓抑制期感染的相关因素,差异均有统计学意义(均P <0. 05)。消化道肿瘤患者化疗后发生感染的独立危险因素为并发症、不规范操作和血清白蛋白含量低,差异均有统计学意义(均P <0. 05)。结论消化道肿瘤患者化疗后骨髓抑制期的主要感染部位为呼吸系统、泌尿系统及皮肤,病原菌主要以革兰氏阴性菌为主,且并发症、不规范操作和低血清白蛋白为独立危险因素。

Objective To investigate the distribution of infection sites and pathogens in patients with gastrointestinal cancer after chemotherapy,and to analyze the related risk factors.Methods A total of523 patients with digestive tract cancer who were given chemotherapy at Huanggang Central Hospital from September 2015 to September 2018 were selected as the subjects.According to the infection after chemotherapy,they were divided into an infection group(67 patients)and non-infection group(456 patients).The infection site and pathogen distribution characteristics of the infected group were observed,and univariate analysis and multivariate regression analysis were performed.Results Among 532 patients,infection was found in 67 patients(12.8%),mainly including respiratory infection,urinary system and skin infection and digestive tract infection.A total of 46 pathogen were detected and the detection rate was 68.7%.The species were mainly Gram-negative bacteria(58.7%),followed by Gram-positive bacteria(23.9%),and fungi(17.4%).Gram-negative bacteria mainly included Pseudomonas aeruginosa and Klebsiella pneumoniae.Gram-positive bacteria mainly included Staphylococcus aureus,and fungi mainly included Candida.Age,complications,irregular operation,serum albumin were risk factor for myelosuppression-associated infection after chemotherapy in digestive tract tumors(all P<0.05).Complications,irregular operation and low serum protein levels were independent risk factors for myelosuppression-associated infection after chemotherapy in digestive tract tumors(all P<0.05).Conclusion The main infection sites in patients with digestive tract cancer after chemotherapy are respiratory system,urinary system and skin.The pathogens are mainly Gram-negative bacteria.Complications,irregular operation and serum albumin are independent risk factors.