晚期肺癌化疗患者医院感染的病原学特点及影响因素分析  

Pathogenic characteristics and influencing factors of nosocomial infection in patients with advanced lung cancer undergoing chemotherapy

作　　者：徐倩倩[1] 朱振华[2] XU Qian-qian;ZHU Zhen-hua(Department of Radiotherapy,Fuyang People’s Hospital,Fuyang,Anhui 236004,China;Department of Hospital Administration Office,Fuyang People’s Hospital,Fuyang,Anhui 236004,China)

机构地区：[1]阜阳市人民医院放疗科,安徽阜阳236004 [2]阜阳市人民医院办公室,安徽阜阳236004

出　　处：《临床肺科杂志》2020年第8期1241-1245,共5页Journal of Clinical Pulmonary Medicine

摘　　要：目的分析晚期肺癌患者化疗后获得医院感染的病原菌分布及耐药性情况,探究化疗晚期肺癌患者发生医院感染的危险因素。方法选取2016年1月-2018年12月363例医院晚期肺癌化疗后85例感染患者作为研究对象,对其系统感染部位及分泌物标本中的病原菌分布进行分析,并采用单因素分析方法分析肺癌病理类型、临床分期、解剖学分型以及年龄、性别等18个因素与患者发生医院感染的联系,确定肺癌晚期化疗患者引起医院感染的危险因素。结果 85例晚期肺癌患者化疗后感染,主要感染部位为呼吸系统45例(52.94%)、消化系统20例(23.53%)和口腔14例(16.47%);共分离病原菌85株,革兰阴性菌50株占58.82%,其中铜绿假单胞菌24株(28.24%),肺炎克雷伯菌14株(16.47%),鲍曼氏不动杆菌12株(14.12%),革兰阳性菌35株占41.18%,其中金黄色葡萄球菌21株(24.71%),粪肠球菌6株(7.06%),真菌8株占9.41%;肺癌病理类型中小细胞肺癌患者感染率高于非小细胞癌患者(P<0.05);临床病理分期结果:小细胞肺癌中局限期肺癌患者感染发生率高于广泛期肺癌患者(P<0.05);非小细胞型肺癌中晚期肺癌患者感染发生率高于早中期肺癌患者(P<0.05);中央型肺癌患者感染率高于周围型肺癌患者的感染率(P<0.05)。多因素logistic回归分析结果显示,既往患有慢性阻塞性肺疾病、病程、住院时间、曾经侵入性操作、白细胞水平、血清白蛋白水平、淋巴细胞CD+3、CD+4、CD+8百分比、抗生素使用、使用免疫抑制剂是晚期肺癌患者医院感染的独立危险因素。结论晚期肺癌患者化疗后医院感染的病原菌分布以革兰阴性菌为主具有一定病原学特征,控制慢性肺部疾病、缩短住院时间、减少侵入性操作、给予营养支持、合理预防性使用抗菌药物等,可降低晚期肺癌患者发生医院感染的机率,延长肺癌晚期化疗患者生存期。Objective To analyze the distribution and drug resistance of nosocomial infection in patients with advanced lung cancer after chemotherapy, and to explore the risk factors of nosocomial infection in patients with advanced lung cancer after chemoradiotherapy. Methods From January 2016 to December 2018, 363 inpatients with advanced lung infection after chemotherapy were collected as the research objects. The distribution of pathogenic bacteria samples were analyzed, and it used single factor analysis method to analyze the relationship of lung cancer pathological type, clinical stage, anatomy type, age, gender and so on with hospital infection, in order to identify the risk factors of hospital infection for lung cancer chemotherapy patients. Results 85 patients with advanced lung cancer were infected after chemotherapy, and the main infection sites were respiratory system in 45 patients(52.94%), digestive system in 20 patients(23.53%) and oral cavity in 14 patients(16.47%). There were 85 plants of pathogenic bacteria, 50 strains of which were gram-negative bacteria(58.82%), including 24 strains of pseudomonas aeruginosa(28.24%), 14 strains(16.47%), klebsiellapneumoniae, and 12 strains of Bowman’s acinetobacter(14.12%). 35 strains(41.18%) were gram positive bacteria, including 21 strains of staphylococcus aureus(24.71%), and 6 stains of enterococcus(7.06%). 8 strains were fungi(9.41%). The infection rate of small cell lung cancer patients was higher than that of non-small cell lung cancer patients(P<0.05). Clinicopathological staging results showed that the infection rate of patients with small cell lung cancer was higher than that of patients with extensive lung cancer( P < 0. 05). The infection rate of advanced lung cancer patients with non-small cell lung cancer was higher than that of early and middle stage lung cancer patients( P < 0. 05). The infection rate of central lung cancer patients was higher than that of peripheral lung cancer patients( P < 0. 05). According to the results of multi-logistic regression

关 键 词：晚期肺癌 化疗 病原菌 医院感染 危险因素 

分 类 号：R734.2[医药卫生—肿瘤]