多发性骨髓瘤患者化疗后医院感染病原菌分布及危险因素分析  

Distribution of pathogens causing nosocomial infections in multiple myeloma patients after chemotherapy and analysis of risk factors

作　　者：陈莉莉[1] 唐小万[1] 江文华[1] 王友群[1] 李建华[1] 

机构地区：[1]台州市第一人民医院血液肿瘤内科,浙江台州318020

出　　处：《中华医院感染学杂志》2014年第21期5365-5367,共3页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科研基金资助项目(2010KYB090)

摘　　要：目的探讨多发性骨髓瘤(MM)患者化疗后医院感染病原菌种类及其危险因素,以降低感染率。方法回顾性分析2010年3月-2013年3月80例多发性骨髓瘤患者临床资料,分析感染部位、感染病原菌种类以及化疗后感染影响因素。结果 80例患者中有21例化疗后发生感染,感染率为26.25%;其中感染部位主要是消化系统占42.85%,其次呼吸道、泌尿系统,分别占23.81%、19.05%;共分离出病原菌23株,其中革兰阳性菌5株占21.73%,革兰阴性菌16株占69.57%,革兰阳性菌中以金黄色葡萄球菌为主占13.03%,革兰阴性菌中以大肠埃希菌为主占26.09%;多因素分析显示,BMI高(β=3.085,OR=21.854)、Dukes分期高(β=3.189,OR=24.247)、合并有糖尿病(β=2.671,OR=25.221)是MM患者化疗后感染的影响因素。结论多发性骨髓瘤患者化疗后容易导致各种病原菌感染,临床上需要加强患者的风险评估,对于合并有糖尿病、临床症状严重以及肥胖的患者应采取有效的预防和控制感染手段。OBJECTIVE To explore the distribution of pathogens causing nosocomial infections in the multiple mye-loma （MM） patients after chemotherapy and analyze the risk factors so as to reduce the incidence of infections . METHODS The clinical data of 80 patients with MM who were treated in the hospital from Mar 2010 to Mar 2013 were retrospectively analyzed ,then the infection sites ,the species of pathogens causing infections ,and the influ-encing factors for infections after chemotherapy were observed .RESULTS Of the 80 patients ,the infections oc-curred in 21 cases after the chemotherapy ,with the infection rate of 26 .25% ;the patients with gastrointestinal tract infections accounted fro 42 .85% ,the patients with respiratory tract infections 23 .81% ,the patients with u-rinary tract infections 19 .05% .A total of 23 strains of pathogens have been isolated ,among which there were 5 （21 .73% ） strains of gram-positive bacteria and 16 （69 .57% ） strains of gram-negative bacteria ;the Staphylococ-cus aureus was the predominant species of gram-positive bacteria ,accounting for 13 .03% ,and the Escherichia coli was dominant among the gram-negative bacteria ,accounting for 26 .09% .The multivariate analysis indicated that the high BMI （β=3 .085 ,OR=21 .854） ,high Dukes stage （β=3 .189 ,OR=24 .247） ,and complication of diabetes mellitus （β= 2 .671 ,OR = 25 .221 ） were the influencing factors for the infections after the chemotherapy . CONCLUSION The patients with MM tended to be infected with various species of pathogens after the chemother-apy .It is necessary for the hospital to strengthen the risk assessment for the patients and take effective prevention and control measures for the patients complicated with diabetes ,severe clinical symptoms ,or obesity .

关 键 词：多发性骨髓瘤 医院感染 病原菌 影响因素 

分 类 号：R181.32[医药卫生—流行病学]