肿瘤患者放化疗后医院感染的相关因素分析  

Related factors for nosocomial infections in tumor patients after chemoradiotherapy

作　　者：冯惠春[1] 夏冰[2] 顾敏[2] 邵剑琴[2] 

机构地区：[1]杭州市第一人民医院护理部,浙江杭州310006 [2]杭州市肿瘤医院放疗科,浙江杭州310004

出　　处：《中华医院感染学杂志》2015年第5期1082-1084,共3页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技基金资助项目(2012KYB154)

摘　　要：目的探讨肿瘤患者放化疗后发生医院感染的相关因素,并提供预防控制对策。方法以2009年3月-2013年5月在医院进行放化疗后发生医院感染的105例恶性肿瘤患者作为研究对象,采集标本进行细菌培养及药敏试验,对病原菌和易感因素采用SPSS15.0软件进行分析,对有显著性差异的影响因素进行多因素logistic回归分析,总结导致感染的相关因素和预防控制对策。结果共1 552例恶性肿瘤患者放化疗后发生医院感染105例,感染率为6.76%;感染部位以呼吸道感染为主,其中上呼吸道感染31.43%、下呼吸道感染20.0%,其次为泌尿道感染、血液感染和皮肤软组织感染等;共分离出病原菌117株,其中革兰阴性菌51株占43.59%,主要为大肠埃希菌、鲍氏不动杆菌、铜绿假细胞菌和肺炎克雷伯菌,其次为真菌和革兰阳性菌分别占31.62%、24.79%;经统计分析发现,治疗方式、骨髓抑制程度、住院时间、营养状况、侵入性操作、肿瘤分期、抗菌药物使用与医院感染的发生差异有统计学意义(P<0.05)。结论肿瘤患者放化疗后出现骨髓抑制、免疫力降低,是医院感染的高危人群,必须加强医院感染的管理与控制,制定行之有效的护理对策,对易感因素进行重点预防,规范抗菌药物的使用,有效降低感染发生率。OBJECTIVE To explore the related factors for nosocomial infections in the tumor patients after chemora‐diotherapy so as to put forward prevention countermeasures .METHODS A total of 150 malignant tumor patients who underwent the chemoradiotherapy from Mar 2009 to May 2013 and were complicated with nosocomial infec‐tions were recruited as the study objects ,then the specimens were collected for bacterial culture and drug suscepti‐bility testing , the pathogens and predisposing factors for the nosocomial infections were analyzed by using SPSS15 .0 software ,the multivariate logistic regression analysis was performed for the influencing factors with significant differences so as to define the related factors for the infections ,and the prevention measures were put forward .RESULTS The nosocomial infections occurred in 105 of 1 552 malignant tumor patients after the chemora‐diotherapy with the infection rate of 6 .76% ,among whom the patients with upper respiratory tract infections ac‐counted for 31 .43% ,the patients with lower respiratory tract infections 20 .0% ,followed by the patients with u‐rinary tract infections ,the patients with blood infections ,and the patients with skin and soft tissue infections .To‐tally 117 strains of pathogens have been isolated ,including 51 （43 .59% ） strains of gram‐negative bacteria ,the fungi （31 .62% ） ,and the gram‐positive bacteria （24 .79% ）;the Escherichia coli , Acinetobacter baumannii , Pseudomonas aeruginosa ,and K lebsiella pneumoniae were dominant among the gram‐negative bacteria .The sta‐tistical analysis revealed that the incidence of nosocomial infections was associated with the treatment mode ,bone marrow suppression degree ,length of hospital stay ,nutrition status ,invasive operation ,tumor stage ,and use of antibiotics （P〈0 .05） .CONCLUSION The tumor patients tend to have the bone marrow suppression and reduced immunity and are the population at high risk of nosocomial infections ,and it is necessary to strengthen the cont

关 键 词：肿瘤 放化疗 骨髓抑制 医院感染 预防对策 

分 类 号：R181.32[医药卫生—流行病学]