非小细胞肺癌患者化疗期间医院感染影响因素筛查与分析
|
摘要
目的分析非小细胞肺癌患者化疗期间医院感染影响因素,旨在降低医院感染率、阻断感染传播途径,提高感染防控效果。方法选取2016年12月-2018年1月医院非小细胞肺癌化疗患者348例,目标性监测非小细胞肺癌化疗期间医院感染人群,检测感染人群的血常规(如白细胞计数、血红蛋白)和免疫学指标(如CD_4~+、CD_8~+))。将单因素分析有统计学意义的纳入多因素分析,采用Logistic回归模型分析医院感染的影响因素。结果348例非小细胞肺癌化疗期间医院感染39例、感染率11.21%,其中感染部位以呼吸系统感染为主,18例占46.15%;多元Logistic回归分析结果显示,吸烟史、2型糖尿病史、病理分型、病理分期、化疗周期及侵入性操作、抗菌药物使用时间、病房环境、中性粒细胞缺乏、贫血、CD_4~+/CD_8~+是非小细胞肺癌患者化疗期间医院感染高危风险因素,而预防使用抗菌药物是非小细胞肺癌患者化疗期间医院感染保护性因素。结论加强感染因素重点人群的早期辨别与感染防控,有助于降低医院感染率、阻断感染传播途径,提高感染防控效果。
OBJECTIVE To analyze the influencing factors of nosocomial infection during chemotherapy in patients with non-small cell lung cancer,aiming at reducing the nosocomial infection rate,blocking the infection transmission route,and improving the infection prevention and control effect.METHODS 348 patients with non-small cell lung cancer chemotherapy in hospital from Dec.2016 to Jan.2018 were selected.Targeted monitoring was conducted for patients with nosocomial infection during non-small cell lung cancer chemotherapy,and laboratory indicators of the infected population(including blood routine such as white blood cell count and hemoglobin,and immunological indicators such as CD_4~+and CD_8~+).The factors with statistical significance in univariate analysis were included in multivariate analysis,and logistic regression model was used to analyze the risk factors associated with nosocomial infection.RESULTS There were 39 cases of nosocomial infection in the 348 patients,the infection rate was 11.21%.The respiratory infection was the dominant infection site,accounting for 46.15%(18 cases).Multivariate logistic regression analysis showed that smoking history,type 2 diabetes history,pathological type,pathological stage,chemotherapy cycle and invasive operation,antibacterial use time,ward environment,neutrophil deficiency,anemia and CD_4~+/CD_8~+were high-risk factors for nosocomial infection during chemotherapy in patients with non-small lung cancer,and the prophylactic use of antibiotics was a protective factor for nosocomial infection during chemotherapy in patients with non-small cell lung cancer.CONCLUSIONStrengthening the early identification and infection prevention and control of key populations could help to reduce the nosocomial infection rate,block the transmission route of infection,and improve the prevention and control effect of infection.
OBJECTIVE To analyze the influencing factors of nosocomial infection during chemotherapy in patients with non-small cell lung cancer,aiming at reducing the nosocomial infection rate,blocking the infection transmission route,and improving the infection prevention and control effect.METHODS 348 patients with non-small cell lung cancer chemotherapy in hospital from Dec.2016 to Jan.2018 were selected.Targeted monitoring was conducted for patients with nosocomial infection during non-small cell lung cancer chemotherapy,and laboratory indicators of the infected population(including blood routine such as white blood cell count and hemoglobin,and immunological indicators such as CD_4~+and CD_8~+).The factors with statistical significance in univariate analysis were included in multivariate analysis,and logistic regression model was used to analyze the risk factors associated with nosocomial infection.RESULTS There were 39 cases of nosocomial infection in the 348 patients,the infection rate was 11.21%.The respiratory infection was the dominant infection site,accounting for 46.15%(18 cases).Multivariate logistic regression analysis showed that smoking history,type 2 diabetes history,pathological type,pathological stage,chemotherapy cycle and invasive operation,antibacterial use time,ward environment,neutrophil deficiency,anemia and CD_4~+/CD_8~+were high-risk factors for nosocomial infection during chemotherapy in patients with non-small lung cancer,and the prophylactic use of antibiotics was a protective factor for nosocomial infection during chemotherapy in patients with non-small cell lung cancer.CONCLUSIONStrengthening the early identification and infection prevention and control of key populations could help to reduce the nosocomial infection rate,block the transmission route of infection,and improve the prevention and control effect of infection.
引文
[1]余艺文,王传鹏,韩耀风,等.中国非吸烟女性肺癌危险因素的Mete分析[J].中华流行病学杂志,2016,37(2):268-272.
[2]Zheng C,Han X,Feng S,et al.Value of urine sediment analyzer in the screening of urinary tract infection in cancer patients[J].Zhong hua Zhong Liu Za Zhi,2016,38(1):35-39.
[3]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[4]Luo H,Yu X,Liang N,et al.The effect of induction chemotherapy in patients with locally a dvanced nonsmall cell lung cancer who received chemoradiotherapy:a systematic review and meta-analysis[J].Medicine(Baltimore),2017,96(8):e6165.
[5]Akata K,Kawanami T,Yatera K,et al.In-hospital airborne tuberculous infection from a lesion of calcified pleural thickening during thoracic surgery in a patient with lung cancer[J].Intern Med,2015,54(20):2699-703.
[6]陈俊,庞林荣,李晖,等.肺癌放化疗患者呼吸系统二重感染病原菌分布与耐药性分析[J].中华医院感染学杂志,2016,26(9):1964-1966.
[7]Datta S,Choudhury D,Das A,et al.Paclitaxel resistance development is associated with biphasic changes in reactive oxygen specics,mitochond rial membrane potential and autophagy with elevated energy production capacity in lung cancer cells:a chronological study[J].Tumour Biol,2017,39(2):1010428317694314.
[8]林伟,陈素秀,张文熠.晚期肺癌患者化疗后医院感染病原菌分布及耐药性分析[J].中华医院感染学杂志,2017,27(13):2987-2990.
[9]Mencoboni M,Filiberti RA,Taveggia P,et al.Outcome of EGFR inhib itors treatment in ad vanced NSCLC patients,not enrolled in clinical trials[J].Neoplasma,2017,64(2):253-261.
[10]金剑英,朱延安,郭群依,等.老年肺癌化疗患者合并肺部感染影响因素分析[J].浙江医学,2018,40(8):817-819.
[11]Cruvinel E,Richter KP,Stoney C,et al.Charting apath to pragmatic tobacco treatment research[J].Am J Prev Med,2016,51(4):630-636.
[12]诸静兰,陈惠,栾伟.老年肺癌患者术后合并下呼吸道感染的相关因素分析[J].国际肿瘤学杂志,2016,43(2):95-98.
[13]Nuzhat Z,Kinhal V,Sharma S,et al.Tumour-derived exosomes as a signature of pancreatic cancer-liquid biopsies as indicators of tumour progression[J].Oncotarget,2017,8(10):17279-17291.
[14]Satankova M,Brat K,Tomiskova M,et al.Effect of erlotinib in 2nd and 3rd line anticancer treatment in patients with squamous cell lung cancer-case series[J].Klin Onkol Spring,2017,30(2):131-135.
[15]王炳平,李方华,朱增宽,等.非小细胞肺癌患者化疗期间医院感染的相关因素分析[J].中华医院感染学杂志,2016,26(20):4692-4694.
[2]Zheng C,Han X,Feng S,et al.Value of urine sediment analyzer in the screening of urinary tract infection in cancer patients[J].Zhong hua Zhong Liu Za Zhi,2016,38(1):35-39.
[3]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[4]Luo H,Yu X,Liang N,et al.The effect of induction chemotherapy in patients with locally a dvanced nonsmall cell lung cancer who received chemoradiotherapy:a systematic review and meta-analysis[J].Medicine(Baltimore),2017,96(8):e6165.
[5]Akata K,Kawanami T,Yatera K,et al.In-hospital airborne tuberculous infection from a lesion of calcified pleural thickening during thoracic surgery in a patient with lung cancer[J].Intern Med,2015,54(20):2699-703.
[6]陈俊,庞林荣,李晖,等.肺癌放化疗患者呼吸系统二重感染病原菌分布与耐药性分析[J].中华医院感染学杂志,2016,26(9):1964-1966.
[7]Datta S,Choudhury D,Das A,et al.Paclitaxel resistance development is associated with biphasic changes in reactive oxygen specics,mitochond rial membrane potential and autophagy with elevated energy production capacity in lung cancer cells:a chronological study[J].Tumour Biol,2017,39(2):1010428317694314.
[8]林伟,陈素秀,张文熠.晚期肺癌患者化疗后医院感染病原菌分布及耐药性分析[J].中华医院感染学杂志,2017,27(13):2987-2990.
[9]Mencoboni M,Filiberti RA,Taveggia P,et al.Outcome of EGFR inhib itors treatment in ad vanced NSCLC patients,not enrolled in clinical trials[J].Neoplasma,2017,64(2):253-261.
[10]金剑英,朱延安,郭群依,等.老年肺癌化疗患者合并肺部感染影响因素分析[J].浙江医学,2018,40(8):817-819.
[11]Cruvinel E,Richter KP,Stoney C,et al.Charting apath to pragmatic tobacco treatment research[J].Am J Prev Med,2016,51(4):630-636.
[12]诸静兰,陈惠,栾伟.老年肺癌患者术后合并下呼吸道感染的相关因素分析[J].国际肿瘤学杂志,2016,43(2):95-98.
[13]Nuzhat Z,Kinhal V,Sharma S,et al.Tumour-derived exosomes as a signature of pancreatic cancer-liquid biopsies as indicators of tumour progression[J].Oncotarget,2017,8(10):17279-17291.
[14]Satankova M,Brat K,Tomiskova M,et al.Effect of erlotinib in 2nd and 3rd line anticancer treatment in patients with squamous cell lung cancer-case series[J].Klin Onkol Spring,2017,30(2):131-135.
[15]王炳平,李方华,朱增宽,等.非小细胞肺癌患者化疗期间医院感染的相关因素分析[J].中华医院感染学杂志,2016,26(20):4692-4694.