恶性肿瘤住院患者下呼吸道感染主要病原菌分布及危险因素分析  

Analysis on Distribution of Pathogenic Bacteria in Lower Respiratory Tract Infection and the Related Risk Factors for Hospitalized Cancer Patients

作　　者：郑微唯[1] 王加强[1] 王丹[1] 周琴[1] 许颖[1] 

机构地区：[1]成都医学院第一附属医院检验科,成都610500

出　　处：《肿瘤预防与治疗》2015年第3期131-134,共4页Journal of Cancer Control And Treatment

摘　　要：目的:分析恶性肿瘤并发下呼吸道感染患者的病原菌分布情况,探讨发生感染的相关危险因素。方法:选择成都医学院第一附属医院2011年1月至2014年6月收治的1 040例恶性肿瘤患者中的168例并发下呼吸道感染患者作为病例组,对呼吸道分泌物进行细菌培养,按照1∶2的比例随机选择同期住院、相同癌种(分期一致)且未发生下呼吸道感染的住院患者作为对照组。回顾性收集患者的临床资料,分别采用单因素χ2检验或t检验以及多因素Logistic回归分析对恶性肿瘤患者发生下呼吸道感染的危险因素进行筛选。结果:168例下呼吸道感染患者标本中,共分离出病原菌224株;检出革兰氏阴性菌144株,占64.3%;革兰氏阳性菌42株,占18.8%;真菌38株,占16.96%;检出率前5位的病原菌依次为:铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、白色假丝酵母菌、鲍氏不动杆菌,分别占17.9%、15.2%、13.4%、12.9%和11.6%。经多因素Logistic回归分析显示:抗生素联合使用(OR=8.908)、使用抗生素(OR=3.797)、化疗(OR=2.130)、住院时间(OR=2.042)、年龄(OR=1.957)是恶性肿瘤患者发生下呼吸道感染的独立危险因素。结论:恶性肿瘤下呼吸道感染患者主要以革兰氏阴性菌为主;抗生素联合使用、使用抗生素、化疗、住院时间和年龄是恶性肿瘤患者并发下呼吸道感染的独立危险因素。Objective： To analyze the distribution of pathogenic bacteria in lower respiratory tract infection（ LRTI）in cancer patients,and to explore the related risk factors,thus to provide basis for prevention and control of hospital infection. Methods： One hundred and sixty-eight cases of cancer patients complicated with LRTI from January 2011 to June2014 in our hospital were enrolled in this study as case group and all patients received the bacterial culture of respiratory tract secretions. Patients without LRTI who were hospitalized at the same period and got the same cancer at same stage were randomly selected as control group according to the proportion of 1 ∶ 2. Clinical data were retrospectively collected and analyzed using χ2test or t test. Multivariate Logistic regression analysis was adopted to screen risk factors for cancer patients with LRTI. Results： Two hundred and twenty-four strains of pathogenic bacteria were isolated from the samples in case group. Among which,gram negative bacilli accounted for 64. 3%（ 144 strains）; gram positive bacteria accounted for18. 8%（ 42 strains）; fungi 16. 96%（ 38 strains）. The top 5 bacterias were： Pseudomonas aeruginosa,Klebsiella pneumoniae,Escherichia coli,Candida albicans,Acinetobacter baumannii,which accounted for 17. 9%,15. 2%,13. 4%,12. 9% and 11. 6% of all detected pathogenic bacterias respectively. Multivariate Logistic regression analysis showed that combined use of antibiotics（ OR = 8. 908）,antibiotics（ OR = 3. 797）,chemotherapy（ OR = 2. 130）,the hospitalization time（ OR = 2. 042） and age（ OR = 1. 957） were independent risk factors for LRTI in cancer patients.Conclusion： The main pathogen of cancer patients with LRTI is gram negative bacteria. Combined use of antibiotics,antibiotics,chemotherapy,hospitalization time and age are independent risk factors for LRTI in cancer patients.

关 键 词：恶性肿瘤 下呼吸道感染 病原菌 危险因素 

分 类 号：R446.5[医药卫生—诊断学]