原发性肝癌肝动脉化疗栓塞术后医院感染病原菌及其影响因素  

Pathogens isolated from primary liver cancer patients with nosocomial infection after transhepatic arterial chemotherapy and embolization and influencing factors

作　　者：王琪[1] 张玉[1] 王芳芳[1] 郭春霞[1] 杨振浩[1] 何行昌[2] WANG Qi;ZHANG Yu;WANG Fang-fang;GUO Chun-xia;YANG Zhen-hao;HE Xing-chang(The First Affiliated Hospital of Nanyang Medical College,Nanyang,Henan 473000,China;不详)

机构地区：[1]南阳医学高等专科学校第一附属医院感染性疾病科,河南南阳473000 [2]商丘市第一人民医院胃肠肝胆外科,河南商丘476100

出　　处：《中华医院感染学杂志》2023年第17期2634-2638,共5页Chinese Journal of Nosocomiology

基　　金：河南省医学科技攻关计划联合项目(LHGJ20191495)。

摘　　要：目的分析原发性肝癌患者肝动脉化疗栓塞术(TACE)后医院感染病原菌分布,并构建影响因素预测模型.方法回顾性收集2020年1月-2022年5月南阳医学高等专科学校第一附属医院收治的行TACE治疗的746例原发性肝癌患者临床资料,根据患者术后是否发生医院感染,分为感染组57例和未感染组689例,分析感染患者病原菌分布特点及炎症因子水平,多因素Logistic回归分析原发性肝癌TACE术后医院感染影响因素,并构建预测模型,受试者工作特征(ROC)曲线分析模型的预测价值.结果57例原发性肝癌TACE术后医院感染患者共分离出68株病原菌,主要感染病原菌为大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌和凝固酶阴性葡萄球菌;感染组血清降钙素原(PCT)、C-反应蛋白(CRP)、白细胞介素-8(IL-8)水平均高于未感染组(P<0.05);多因素Logistic回归分析结果显示,合并糖尿病、有腹水、术中出血量≥500 ml、住院时间>20 d、抗菌药物应用时间≥7 d为原发性肝癌患者TACE术后医院感染的独立危险因素(P<0.05),据此构建的预测模型,ROC曲线分析结果显示,当Logit(P)>11.96时,曲线下面积(AUC)为0.832.结论原发性肝癌TACE术后医院感染病原菌主要为大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌、凝固酶阴性葡萄球菌,感染可引起炎性因子水平升高,其危险因素包括合并糖尿病、有腹水、术中出血量≥500 ml、住院时间>20 d、抗菌药物应用时间≥7 d,据此构建的模型预测价值较好.OBJECTIVE To analyze the distribution of pathogens isolated from the primary liver cancer patients with nosocomial infection after transhepatic arterial chemotherapy and embolization(TACE)and establish the prediction model based on the influencing factors.METHODS The clinical data were retrospectively collected from 746 primary liver cancer patients who were treated with TACE in the First Affiliated Hospital of Nanyang Medical College from Jan 2020 to May 2022.The patients were divided into the infection group with 57 cases and the no infection group with 689 cases according to the status of postoperative nosocomial infection.The distribution of pathogens and influencing factors were analyzed,multivariate logistic regression analysis was performed for the influencing factors for the postoperative nosocomial infection,the prediction model was established,and the predictive value of the model was analyzed by means of receiver operating characteristic(ROC)curves.RESULTS A to-tal of 68 strains of pathogens were isolated from the 57 primary liver cancer patients with nosocomial infection after TACE;Escherichia coli,Pseudomonas aeruginosa,Staphylococcus aureus and coagulase-negative Staphylococcus were the predominant species of pathogens.The levels of serum procalcitonin(PCT),C-reactive protein(CRP)and interleukin-8(IL-8)of the infection group were higher than those of the no infection group(P<0.05).The result of multivariate logistic regression analysis showed that complication with diabetes mellitus,ascites,intraoperative blood loss volume no less than 500 ml,length of hospital stay more than 20 days and time of antibiotic treatment no less than 7 days were the independent risk factors for the postoperative nosocomial infection in the primary liver cancer patients undergoing TACE(P<0.05).The prediction model was established based on the influencing factors.The result of ROC curve analysis indicated that when Logit(P)was more than ll.96,the area under curve(AUC)was O.832.CONCLUSION E.coli,P.aeruginosa,S.aureus and co

关 键 词：原发性肝癌 肝动脉化疗栓塞术 医院感染 病原菌 影响因素 预测模型 

分 类 号：R735.7[医药卫生—肿瘤]