恶性肿瘤放化疗住院患者医院感染的病原学及预防  

Etiology and Prevention of Hospital Acquired Infectionin Hospitalized Patients with Malignant Tumor Treated with Radiotherapy and Chemotherapy

作　　者：吉祥银 胡炜[1] 宋雪[1] 邹美英 徐德静[1] 王亚欣 张蓉[1] 夏风艳 JI Xiang-yin;HU Wei;SONG Xue;ZOU Mei-ying;XU De-jing;WANG Ya-xin;ZHANG Rong;XIA Feng-yan(Department of Radiotherapy,Jiangsu Cancer Hospital,Jiangsu Cancer Institute,Affiliated Cancer Hospital of Nanjing Medical University,Nanjing,210009)

机构地区：[1]南京医科大学附属肿瘤医院,江苏省肿瘤防治研究所,江苏省肿瘤医院放疗科,210009

出　　处：《岭南急诊医学杂志》2022年第3期248-251,共4页Lingnan Journal of Emergency Medicine

摘　　要：目的:总结恶性肿瘤放化疗住院患者发生医院感染(院感)的病原学,为临床防控院感提供参考。方法:回顾性分析2015年1月至2021年12月江苏省肿瘤医院放疗科9694例恶性肿瘤住院患者住院期间采集的痰、咽拭子、分泌物、尿、导管末端、外周血及导管血培养标本检测结果,由感控科跟踪细菌培养阳性标本患者,排除院外感染、细菌定植、免疫性炎症及标本污染,得到医院感染率和医院感染例次率,分析感染部位与易感因素。结果:9694例住院患者共送检痰、咽试子、分泌物、尿、导管、外周血、导管血培养标本1976份,致病菌阳性标本数253,阳性标本检出率12.8%,医院感染率0.99%,医院感染例次率1.01%。病原学分布以白假丝酵母菌最多,其次为金黄色葡萄球菌、产酸克雷伯菌、肺炎克雷伯菌、铜绿假单胞菌、人葡萄球菌、近平滑假丝酵母菌、大肠杆菌、阴沟肠杆菌。易感因素有病期晚、住院时间长、营养不良、骨髓抑制、侵入性操作、抗生素的不合理使用与放射性皮肤黏膜炎。结论:恶性肿瘤放化疗患者多种因素导致院感,需通过正确有效的预防减少其发生。Objective:To summarize the etiological types of hospital acquired infection(HAI)in hospitalized patients with malignant tumors treated with chemotherapy and radiotherapy,and to provide HAI.Methods:The clinical data of 9694 hospitalized patients with malignant tumors in the Radiotherapy Departmentwere retrospectively analyzed from Jan 2015 to Dec 2021.The results of culture specimensofsputum,pharyngeal test,secretion,urine,catheter end,peripheral blood and catheter bloodwererecorded.Patients with positive bacterial culture specimens were tracked bythe infection control department.The out-of-hospital infection,bacterial colonization,immune inflammation,and specimen contamination were excluded.Therateand the number of HAI were calculated and the infection site and predispositional factors were analyzed.Results:A total of 1976 samples of sputum,pharyngeal test,secretion,urine,catheter,peripheral blood,and catheter blood were sent for examination in 9694 cases,and 253 positive samples were found with pathogenic bacteria.The detection rate of positive samples was 12.8%.The rate of HAI was 0.99%,and the hospital infection rate was 1.01%.For the etiological distribution of bacteria,Candida albicans was present in the majority ofspecimens,followed by Staphylococcus aureus,Klebsiella oxytoca,Klebsiella pneumoniae,Pseudomonas aeruginosa,Staphylococcus hominis,Candida parapsilosis bacteria,Escherichia coli,Enterobacter cloacae.The susceptibilityfactors werelate stage of disease,long hospital stay,malnutrition,myelosuppression,invasive procedures,and irrational use of antibioticsandradiation mucositis.Conclusion:The patients with malignant tumor treated withradiotherapy and chemotherapy can suffer from HAI due to many factors,which should be reduced through correct and effective prevention.

关 键 词：恶性肿瘤 放化疗 医院感染 病原学种类 预防 

分 类 号：R446.5[医药卫生—诊断学]