2011年至2014年放疗科医院感染发生率及危险因素回顾性分析  

Retrospective analysis of nosocomial infection and risk factors in tumor radiotherapy department in 4 years

作　　者：李建锋[1] 陈宏武[2] 牛媛媛[3] 潘德茂[2] 张常然[3] 牛道立[1] 

机构地区：[1]广州医科大学附属第一医院放疗科,510120 [2]中山大学附属第一医院东院急诊科,广州510700 [3]中山大学附属第一医院东院呼吸科,广州510700

出　　处：《中华临床医师杂志（电子版）》2016年第2期307-312,共6页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的分析4年来我院放疗科患者医院感染的特点及危险因素,为临床治疗策略的制定提供参考。方法回顾性分析2011年至2014年我院放疗科发生医院感染的65例患者的临床资料,统计其医院感染的发生率、感染部位、病原菌的分布及其危险因素;所有数据采用SPSS 19.0软件进行统计分析。结果 4年来共收治患者2 136例,发生医院感染65例,感染率为3.04%;例次感染为72例,例次感染率为3.37%。感染部位以呼吸道、泌尿道、胃肠道位居前三位,构成比分别为45.84%、22.22%、12.50%。共分离出68株病原体,革兰阴性菌菌株44株(64.71%)、革兰阳性菌菌株15株(22.06%)、真菌9株(13.24%)。其中,鲍曼不动杆菌感染率最高(38.24%);其次是大肠埃希菌,肠球菌、铜绿假单胞菌及念珠菌均排在第三位。高龄(≥65岁)、既往3个月内曾罹患感染、白细胞计数下降(<1.5×109/L)、住院天数超长(≥30 d)、广谱抗生素使用时间长(≥7 d)、近期同时接受过免疫抑制治疗及入院后行侵入性操作均是医院感染的危险因素。住院天数≥30 d的OR值最大(19.069),为医院感染的最主要影响因素。结论放疗科患者自身免疫力低下,容易发生医院感染,必须加强病原学监测和管理;罹患医院感染的危险因素较多,应针对危险因素采取相应的预防及治疗策略,从而有效控制医院感染率。Objective To analyze the feature of nosocomial infection in patients with malignant tumor after radiotherapy.Besides,to investigate the risk factors of them,so as to provide guidance for clinical treatment.Methods The clinical data of 65 patients who underwent radiotherapy in our hospital from 2011 to 2014 were retrospectively analyzed,then the incidence of nonsocial infections,infection sites,distribution of pathogens,and risk factors were taken for statistics,and the statistical analysis of all the data was performed with the use of SPSS 19.0 software.Results 2 136 patients were treated in 4 years,and 65 patients acquired nonsocial infection with the infection rate of 3.04%.The number of invective cases was72 and the infection rate of 3.37%.The top three infection sites were respiratory tract,urinary tract and gastrointestinal tract,and the ratio of the infection were 45.84%,22.22%and 12.50%,respectively.There were 68 pathogens isolated,with 44 stains of gram negative bacteria（64.71%）,15 stains of gram positive bacteria（22.06%） and 9 stains of fungi（13.24%）.Among them,the infection rate of Antibacterial Badman was the highest（38.24%）,followed by Escherichia coil,and Enterococcus and Pseudomonas aeruginosa and Candida were all ranked in third place.There were seven risk factors of nonsocial infection,including,elderly（over 65 years）,once infection in the previous 3 months,white blood cell count decreased（1.5×l0~9/L）,longer hospitalization days（equal to or more than 30 days）,broad-spectrum antibiotic use for a long time（more than or equal to 7 days）,recently received immunosuppressive therapy and the patients underwent invasive operation,respectively.Hospitalization days were equal to or more than 30 days with the maximum OR value（19.069）,which was the main influence factor for the nonsocial infection.Conclusions The patients with low immune function were easily occurred to nonsocial infection after radiotherapy.We must strengthen the pathogen monitoring and management.Because

关 键 词：肿瘤 放射治疗 交叉感染 回顾性研究 

分 类 号：R197.323[医药卫生—卫生事业管理] R730.55[医药卫生—公共卫生与预防医学]