晚期肺癌化疗患者医院感染的病原学特点及影响因素分析  

Etiological characteristics and influencing factors for nosocomial infection in advanced lung cancer patients undergoing chemotherapy

作　　者：王莹[1] 胡一宇[1] 徐惠芳[1] 刘雪红[1] 郑玉立[1] 潘海红 WANG Ying;HU Yi-yu;XU Hui-fang;LIU Xue-hong;ZHENG Yu-li;PAN Hai-hong(Zhejiang Hospital,Hangzhou ,Zhejiang 310013,China)

机构地区：[1]浙江医院肿瘤科

出　　处：《中华医院感染学杂志》2019年第1期63-66,70,共5页Chinese Journal of Nosocomiology

摘　　要：目的研究晚期肺癌化疗患者医院感染病原学特点与影响因素分析。方法选取2016年1月-2017年2月医院收治的晚期肺癌化疗患者172例,观察和记录纳入患者的临床资料,单因素及多因素Logistic回归分析医院感染的影响因素,采集感染患者临床标本进行病原菌的培养与鉴定。结果 172例晚期肺癌化疗患者发生医院感染50例,感染率为29.07%。共分离病原菌株70株,革兰阴性菌48株占68.57%,主要以铜绿假单胞菌和大肠埃希菌为主,革兰阳性菌16株占22.86%,真菌6株占8.57%;合并糖尿病、吸烟、化疗周期、侵入性操作、住院时间、联合抗菌药物使用状况、解剖学部位、操作人员手卫生和白细胞计数、血红蛋白、白蛋白、CD3^+、CD4^+、CD8^+水平是晚期肺癌化疗患者医院感染的影响因素(P<0.05)。结论晚期肺癌化疗患者医院感染病原菌仍以革兰阴性菌感染为主,但真菌感染的出现应引起临床医师足够重视。同时加强患者医院感染影响因素识别,目标性监测重点人群,有利于降低医院感染率、延长生存期。OBJECTIVE To explore the etiological characteristics and influencing factors for nosocomial infection in the advanced lung cancer patients undergoing chemotherapy.METHODS A total of 172 advanced lung cancer patients who received chemotherapy in the hospital from Jan 2016 to Feb 2017 were enrolled in the study,the clinical data of the enrolled patients were observed and recorded,univariate analysis and multivariate logistic regression analysis were performed for the influencing factors for the nosocomial infection,the clinical specimens that were collected from the patients with infection were cultured,and the isolated pathogens were identified.RESULTS Of the 172 advanced lung cancer patients undergoing chemotherapy,50 had nosocomial infection,with the infection rate 29.07%.Totally 70 strains of pathogens were isolated,48(68.57%)of which were gram-negative bacteria,16(22.86%)were gram-positive bacteria,and 6(8.57%)were fungi.Pseudomonas aeruginosa and Escherichia coli were the predominant species of the gram-negative bacteria.The influencing factors for the nosocomial infection in the advanced lung cancer patients undergoing chemotherapy included diabetes mellitus,smoking,chemotherapy cycle,invasive procedure,length of hospital stay,combined use of antibiotics,anatomical site,hand hygiene of operation staff and white blood cell counts as well as the levels of hemoglobin,albumin,CD3^+,CD4^+and CD8^+(P<0.05).CONCLUSIONThe gram-negative bacteria are dominant among the pathogens causing then nosocomial infection in the advanced lung cancer patients undergoing chemotherapy,however,it is necessary for the clinicians to attach great importance to the emerging fungal infection,identify the influencing factors for the nosocomial infection and strengthen the targeted monitoring of the high-risk population so as to reduce the incidence of nosocomial infection and prolong the survival time.

关 键 词：肺癌 晚期 化疗 病原菌 影响因素 

分 类 号：R734.2[医药卫生—肿瘤]