膀胱癌老年患者发生医院感染的病原菌种类及危险因素分析  

Distribution of pathogens causing nosocomial infections in elderly patients with bladder cancer and analysis of risk factors

作　　者：黄翔[1] 蔡海荣[1] 施思[1] 

机构地区：[1]瑞安市人民医院泌尿外科,浙江瑞安325200

出　　处：《中华医院感染学杂志》2017年第9期2057-2059,2075,共4页Chinese Journal of Nosocomiology

基　　金：温州市科技局基金资助项目(Y20150215)

摘　　要：目的探究老年患者膀胱癌术后发生医院感染的病原菌类型及危险因素,为临床诊治提供参考依据。方法选取于2011年7月-2016年7月医院收治的297例中老年膀胱癌患者为研究对象,收集发生医院感染的患者各项临床资料,并将感染患者切口分泌物送检,观察送检标本中病原菌分布及构成比,对可能引起感染的相关因素进行综合对比分析。结果 297例患者中,发生术后感染51例,感染率为17.17%;51例送检标本中,46例检测出病原菌,检出率为90.20%,共分离出病原菌47株,其中感染革兰阴性菌最多,32株占68.08%、革兰阳性菌10株占21.28%、真菌5株占10.64%;术后感染相关因素分析结果显示,老年膀胱癌患者术后发生医院感染与年龄、合并糖尿病、侵入性操作史、术前感染史、手术方式、手术进行时间以及术后使用抗菌药物等因素有关(P<0.05),与患者性别、是否合并高血压以及住院时间长短无明显关系;多因素logistic分析显示,年龄较大、合并糖尿病、有侵入性操作史、有术前感染史、开腹手术、手术时间较长以及术后未使用抗菌药物治疗是术后发生医院感染的危险因素。结论老年膀胱癌患者术后发生医院感染的病原菌主要为大肠埃希菌、变形菌属和铜绿假单胞菌等革兰阴性菌;年龄较大、合并糖尿病、有侵入性操作史、有术前感染史、开腹手术、手术时间较长以及术后未使用抗菌药物治疗的患者术后更易发生医院感染。OBJECTIVE To explore the distribution of pathogens causing postoperative nosocomial infection in elderly patients with bladder cancer and analyze the risk factors so as to provide guidance for clinical diagnosis and treatment.METHODS A total of 297 elderly patients with bladder cancer who were treated in the hospital from Jul2011 to Jul 2016 were recruited as the study objects,the clinical data were collected from the patients with nosocomial infections,and the incision secretions specimens were submitted.The number and constituent ratios of the pathogens isolated from the submitted specimens were observed,and the risk factors for the infection were comprehensively compared and analyzed.RESULTS Of the 297 patients,51had postoperative infection,with the infection rate 17.17%.The pathogens were detected in 46 of 51submitted specimens,with the detection rate 90.20%.A total of 47 strains of pathogens were isolated,including 32（68.08%）strains of gram-negative bacteria,10（21.28%）strains of gram-positive bacteria,and 5（10.64%）strains of fungi.The result of analysis of the related factors for the postoperative infection indicated that the incidence of the postoperative nosocomial infection in the elderly patients with bladder cancer was associated with age,complication with diabetic mellitus,history of invasive operation,history of preoperative infection,surgical procedure,operation duration,and postoperative use of antibiotics（P〈0.05）,but it did not show significant association with gender,complication with hypertension,and length of hospital stay.Multivariate logistic analysis showed that the risk factors for the postoperative nosocomial infection included old age,complication with diabetic mellitus,history of invasive operation,history of preoperative infection,open surgery,long operation duration,and without postoperative use of antibiotics.CONCLUSION Escherichia coli,Proteus,and Pseudomonas aeruginosa are the major species of pathogens causing the postoperative nosocomial infection in the elderly p

关 键 词：膀胱癌 医院感染 病原菌 危险因素 

分 类 号：R737.14[医药卫生—肿瘤]