老年非小细胞肺癌患者放化疗医院感染病原菌与影响因素分析
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摘要
目的研究老年非小细胞肺癌患者放化疗期间医院感染的病原菌及影响因素。方法选择2016年3月-2017年10月于医院接受放化疗的老年非小细胞肺癌患者236例为研究对象,分析感染患者病原菌及耐药情况;分析患者放化疗周期、白细胞数量、住院时间、侵入性操作、糖尿病史、长期抗菌药物使用史、病程等病历资料,归纳老年非小细胞肺癌患者放化疗期间医院感染的影响因素。结果 236例患者发生医院感染48例,感染率为20.34%;以呼吸道感染为主;共培养分离病原菌株43株,其中革兰阴性菌26株占60.47%,以肺炎克雷伯菌、大肠埃希菌和铜绿假单胞菌为主;革兰阳性菌10株占23.26%,以金黄色葡萄球菌为主;真菌7株占16.28%;药敏试验显示主要革兰阳性菌对青霉素G、克林霉素、四环素、林可霉素耐药率较高,而对万古霉素敏感;革兰阴性菌对头孢曲松、头孢唑林、环丙沙星和庆大霉素耐药性较高,而对美罗培南和亚胺培南敏感;真菌仅对伏立康唑较敏感;年龄、侵入性操作、糖尿病史、长期应用抗菌药物是老年非小细胞肺癌患者放化疗期间医院感染的影响因素(P<0.05)。结论根据老年非小细胞肺癌患者放化疗期间医院感染的病原菌,合理选择抗菌药物,并对医院感染影响因素进行积极防治,以降低医院感染的发生。
OBJECTIVE To study the pathogens and risk factors of nosocomial infection in elderly non-small cell lung cancer patients during radiotherapy and chemotherapy.METHODS 236 elderly patients with non-small cell lung cancer who received radiotherapy and chemotherapy in the hospital from Mar.2016 to Oct.2017 were selected as the study subjects.The pathogens and drug resistance of infected patients were analyzed.The patients' radiotherapy and chemotherapy cycle,leukocyte count,hospitalization time,invasive operation,diabetes history,longterm use of antibiotics,course of disease and other medical records were analyzed.The influencing factors of nosocomial infection in patients with non-small cell lung cancer during radiotherapy and chemotherapy were summarized.RESULTS There were 48 cases of nosocomial infection in the 236 patients,the infection rate was 20.34%,and the most common infection site was respiratory tract.A total of 43 strains of pathogens were isolated,including 26 strains of gram-negative bacteria(60.47%),10 strains of gram-positive bacteria(23.26%),and 7 strains of fungi(16.28%).The gram-negative bacteria were dominated by Klebsiella pneumoniae,Escherichia coli and Pseudomonas aeruginosa,whereas the gram-positive bacteria were dominated by Staphylococcus aureus.Drug sensitivity test results showed that the main gram-positive bacteria were resistant to penicillin G,clindamycin,tetracycline and lincomycin,and sensitive to vancomycin,whereas the gram-negative bacteria were resistant to ceftriaxone,cefazolin,ciprofloxacin and gentamicin,and sensitive to meropenem and imipenem.The fungi were only sensitive to voriconazole.Age,invasive operation,history of diabetes mellitus and long-term use of antibiotics were the influencing factors of nosocomial infection in patients undergoing radiotherapy and chemotherapy(P<0.05).CONCLUSION According to the etiological characteristics of nosocomial infection in elderly patients with non-small cell lung cancer during radiotherapy and chemotherapy,rational selection of antibiotics and active prevention and treatment targeting at the influencing factors of nosocomial infection should be carried out to reduce the incidence of nosocomial infection.
OBJECTIVE To study the pathogens and risk factors of nosocomial infection in elderly non-small cell lung cancer patients during radiotherapy and chemotherapy.METHODS 236 elderly patients with non-small cell lung cancer who received radiotherapy and chemotherapy in the hospital from Mar.2016 to Oct.2017 were selected as the study subjects.The pathogens and drug resistance of infected patients were analyzed.The patients' radiotherapy and chemotherapy cycle,leukocyte count,hospitalization time,invasive operation,diabetes history,longterm use of antibiotics,course of disease and other medical records were analyzed.The influencing factors of nosocomial infection in patients with non-small cell lung cancer during radiotherapy and chemotherapy were summarized.RESULTS There were 48 cases of nosocomial infection in the 236 patients,the infection rate was 20.34%,and the most common infection site was respiratory tract.A total of 43 strains of pathogens were isolated,including 26 strains of gram-negative bacteria(60.47%),10 strains of gram-positive bacteria(23.26%),and 7 strains of fungi(16.28%).The gram-negative bacteria were dominated by Klebsiella pneumoniae,Escherichia coli and Pseudomonas aeruginosa,whereas the gram-positive bacteria were dominated by Staphylococcus aureus.Drug sensitivity test results showed that the main gram-positive bacteria were resistant to penicillin G,clindamycin,tetracycline and lincomycin,and sensitive to vancomycin,whereas the gram-negative bacteria were resistant to ceftriaxone,cefazolin,ciprofloxacin and gentamicin,and sensitive to meropenem and imipenem.The fungi were only sensitive to voriconazole.Age,invasive operation,history of diabetes mellitus and long-term use of antibiotics were the influencing factors of nosocomial infection in patients undergoing radiotherapy and chemotherapy(P<0.05).CONCLUSION According to the etiological characteristics of nosocomial infection in elderly patients with non-small cell lung cancer during radiotherapy and chemotherapy,rational selection of antibiotics and active prevention and treatment targeting at the influencing factors of nosocomial infection should be carried out to reduce the incidence of nosocomial infection.
引文
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[2]支修益,石远凯,于金明等.中国原发性肺癌诊疗规范(2015年版)[J].中华肿瘤杂志,2015,37(1):67-78.
[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] Clinical and laboratory standards insitute.Performance Standards for Antimicrobial Susceptibility Testing:Twenty-Fifth Informational Supplement(M100-S25)[S].Wayne,PA19087USA,2015.
[5]吴丽丽,郭海飞,蔡啸静,等.老年非小细胞肺癌放化疗患者医院感染病原菌耐药性分析[J].中华医院感染学杂志,2016,26(13):2921-2923.
[6] Yan T,Han J,Yu X.E-cadherin mediates adhesion of Aspergillus fumigatus to non-small cell lung cancer cells[J].Tumour Biol,2015,15.
[7] Msaad S,Yangui I,Bahloul N,et al.Do inhaled corticosteroids increase the risk of Pneumocystis pneumonia in people with lung cancer[J].World J Clin Cases,2015,3(9):843-847.
[8] Shih CA,Chen WC,Yu HC,et al.Risk of severe acute exacerbation of chronic HBV infection cancer patients who underwent chemotherapy and did not receive anti‐viral prophylaxis[J].PLoS One,2015,10(8):e0132426.
[9] Noro R,Yoshimura A,Yamamoto K,et al.Alternating chemotherapy with amrubicin plus eisplatin and weekly administration of irinotecan plus cisplatin for extensive_stage small cell lung cancer[J].Anticancer Res,2013,33(3):1117-1123.
[10] Joo EJ,Kang CI,Ha YE,et al.Clinical predictors of Pseudomonas aeruginosa bacteremia among gram-negative bacterial infections in non-neutropenic patients with solid tumor[J].J Infect,2011,63(3):207-214.
[11]李婕,刘杰,杨明.老年肺癌患者肺部真菌感染的病原学分析[J].中华医院感染学杂志,2015,25(14):3156-3157.
[12] Hooker CM,Meguid RA,Hulbert A,et al.Human immunodeficiency virus infection as a prognostic factor in surgical patients with non-small cell lung cancer[J].Ann Thorac Surg,2012,93(2):405-412.
[13]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.