淋巴造血系统恶性肿瘤患者院内感染因素分析
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摘要
目的研究淋巴造血系统恶性肿瘤患者院内感染因素、病原菌分布和流行特点,为院内感染防治提供有力依据。方法收集2013年1月-2018年6月437例淋巴造血系统恶性肿瘤患者临床资料。采用全自动微生物鉴定系统对菌种进行鉴定。采用头孢西丁纸片法对耐甲氧西林金黄色葡萄球菌株进行筛选。采用K-B纸片扩散法测定肺炎克雷伯菌、大肠埃希菌和金黄色葡萄球菌对常见抗生素的耐药情况。采用SPSS 24.0对院内感染有关临床数据进行分析。结果 437例患者院内感染71例,检出病原菌126株,其中革兰阴性菌75株,革兰阳性菌48株和真菌5株;肺炎克雷伯菌27株、大肠埃希菌23株、鲍曼不动杆菌12株、铜绿假单胞菌8株;金黄色葡萄球菌16株、表皮葡萄球菌12株。肺炎克雷伯菌产ESBLs检出率48.00%,大肠埃希菌产ESBLs检出率47.83%,耐甲氧西林金黄色葡萄球菌(MRSA)检出率43.75%。肺炎克雷伯菌和大肠埃希菌未对碳青霉烯类抗生素美罗培南和亚胺培南产生耐药,对加替沙星、阿米卡星耐药程度低。金黄色葡萄球菌对利福平、加替沙星和阿米卡星耐药程度低。男性感染率为17.13%,女性12.00%;<60岁感染率为15.81%,≥60岁23.97%;住院<15 d感染率12.50%,住院≥15 d感染率20.49%;有静脉置管感染率25.81%,无静脉置管14.67%;留置尿管感染率25.00%,未留置尿管14.16%;有侵入性治疗感染率22.64%,无侵入性治疗14.20%。结论由于患者自身体质虚弱、免疫力低下,一旦受到病毒和病菌侵入,易发感染。感染应依据药敏试验结果选用抗生素。碳青霉烯类抗生素可以有效地抑制革兰阴性菌感染,但不能作为首选药物。
Objective To analyze factors for nosocomial infection, pathogen distribution, and epidemiological characteristics in patients with malignant lymphoblastic tumors in order to provide a strong basis for the prevention and treatment of nosocomial infection in patients with malignant lymphoblastic tumors. Methods Clinical data were collected on 437 patients with malignant lymphoblastic tumors who were seen from January 2013 to June 2018. The strains were identified by an automated microbial identification system. ESBL-producing strains were identified using ceftazidime(30 μg per tablet), ceftazidime plus clavulanic acid(30 μg and 10 μg per tablet), cefotaxime(30 μg per tablet), and cefotaxime plus clavulanic acid(30 μg and 10 μg per tablet). Methicillin-resistant Staphylococcus aureus strains were identified using the cefoxitin disk method. The resistance of Klebsiella pneumoniae, Escherichia coli, and S. aureus to common antibiotics was determined using the K-B disk diffusion method. Clinical data on nosocomial infections were analyzed using SPSS 24. Results Pathogen detection: 126 strains of pathogens were detected, including 75 strains of Gram-negative bacteria(58.59%), 48 strains of Gram-positive bacteria(37.50%), and 5 strains of fungi(3.91%). The distribution of Gram-negative bacteria: Klebsiella pneumoniae(27 strains), Escherichia coli(23 strains), Acinetobacter baumannii(12 strains), Pseudomonas aeruginosa(8 strains), Neisseria cloacae(3 strains), Aeromonas hydrophila(1 strain), and Stenotrophomonas maltophilia(1 strain). The distribution of Gram-positive bacteria: Staphylococcus aureus(16 strains), S. epidermidis(12 strains), Enterococcus faecalis(10 strains), E. urinae(8 strains), and Streptococcus(2 strains). The distribution of fungi: Candida albicans(2 strains), C. tropicalis(1 strain), Aspergillus(1 strain), and C. glabra(1 strain). ESBL-producing K. pneumoniae was detected at a rate of 48.00%. ESBL-producing E. coli was detected at a rate of 47.83%, and MRSA was detected at a rate of 43.75%. K. pneumoniae and E. coli were not resistant to the carbapenem antibiotics meropenem and imipenem and were less resistant to gatifloxacin and amikacin. S. aureus was less resistant to rifampicin, gatifloxacin, and amikacin. Analysis of factors for infection: The rate of infection among male patients was 17.13%, and that among female patients was 12.00%, P=0.2733>0.05; The rate of infection among patients under 60 years of age was 15.81%, and that among patients over 60 years of age was 23.97%(P=0.0383<0.05). The rate of infection among patients under 60 years of age was 15.81%, and that among patients over 60 years of age was 23.97%( P<0.05). The rate of infection was 12.50% after hospitalization for less than 15 days and 20.49% after hospitalization for more than 15 days(P=0.0239<0.05). The rate of infection among patients undergoing venous catheterization was 25.81% and that among patients not undergoing venous catheterization was 14.67%(P<0.05). The rate of infection among patients with an indwelling catheter was 25.00% and among patients without an indwelling catheter was 14.16%(P=0.0155<0.05). The rate of infection among patients receiving invasive treatment was 22.64% and that among patients receiving non-invasive treatment was 14.20%(P=0.0403<0.05). Conclusion Because of patients' weakened physical condition and compromised immunity, they were susceptible to infection if they contracted a virus or other pathogen. Rational medical and nursing care should be provided to improve patients' immune function and resistance. Once an infection develops, antibiotics should be chosen according to the results of drug sensitivity testing. Carbapenems can effectively inhibit Gram-negative bacterial infections but cannot be used as the drug of choice.
Objective To analyze factors for nosocomial infection, pathogen distribution, and epidemiological characteristics in patients with malignant lymphoblastic tumors in order to provide a strong basis for the prevention and treatment of nosocomial infection in patients with malignant lymphoblastic tumors. Methods Clinical data were collected on 437 patients with malignant lymphoblastic tumors who were seen from January 2013 to June 2018. The strains were identified by an automated microbial identification system. ESBL-producing strains were identified using ceftazidime(30 μg per tablet), ceftazidime plus clavulanic acid(30 μg and 10 μg per tablet), cefotaxime(30 μg per tablet), and cefotaxime plus clavulanic acid(30 μg and 10 μg per tablet). Methicillin-resistant Staphylococcus aureus strains were identified using the cefoxitin disk method. The resistance of Klebsiella pneumoniae, Escherichia coli, and S. aureus to common antibiotics was determined using the K-B disk diffusion method. Clinical data on nosocomial infections were analyzed using SPSS 24. Results Pathogen detection: 126 strains of pathogens were detected, including 75 strains of Gram-negative bacteria(58.59%), 48 strains of Gram-positive bacteria(37.50%), and 5 strains of fungi(3.91%). The distribution of Gram-negative bacteria: Klebsiella pneumoniae(27 strains), Escherichia coli(23 strains), Acinetobacter baumannii(12 strains), Pseudomonas aeruginosa(8 strains), Neisseria cloacae(3 strains), Aeromonas hydrophila(1 strain), and Stenotrophomonas maltophilia(1 strain). The distribution of Gram-positive bacteria: Staphylococcus aureus(16 strains), S. epidermidis(12 strains), Enterococcus faecalis(10 strains), E. urinae(8 strains), and Streptococcus(2 strains). The distribution of fungi: Candida albicans(2 strains), C. tropicalis(1 strain), Aspergillus(1 strain), and C. glabra(1 strain). ESBL-producing K. pneumoniae was detected at a rate of 48.00%. ESBL-producing E. coli was detected at a rate of 47.83%, and MRSA was detected at a rate of 43.75%. K. pneumoniae and E. coli were not resistant to the carbapenem antibiotics meropenem and imipenem and were less resistant to gatifloxacin and amikacin. S. aureus was less resistant to rifampicin, gatifloxacin, and amikacin. Analysis of factors for infection: The rate of infection among male patients was 17.13%, and that among female patients was 12.00%, P=0.2733>0.05; The rate of infection among patients under 60 years of age was 15.81%, and that among patients over 60 years of age was 23.97%(P=0.0383<0.05). The rate of infection among patients under 60 years of age was 15.81%, and that among patients over 60 years of age was 23.97%( P<0.05). The rate of infection was 12.50% after hospitalization for less than 15 days and 20.49% after hospitalization for more than 15 days(P=0.0239<0.05). The rate of infection among patients undergoing venous catheterization was 25.81% and that among patients not undergoing venous catheterization was 14.67%(P<0.05). The rate of infection among patients with an indwelling catheter was 25.00% and among patients without an indwelling catheter was 14.16%(P=0.0155<0.05). The rate of infection among patients receiving invasive treatment was 22.64% and that among patients receiving non-invasive treatment was 14.20%(P=0.0403<0.05). Conclusion Because of patients' weakened physical condition and compromised immunity, they were susceptible to infection if they contracted a virus or other pathogen. Rational medical and nursing care should be provided to improve patients' immune function and resistance. Once an infection develops, antibiotics should be chosen according to the results of drug sensitivity testing. Carbapenems can effectively inhibit Gram-negative bacterial infections but cannot be used as the drug of choice.
引文
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[12] 孟晶茜, 王建生, 赵瑛瑛, 等. 尿路感染分离金黄色葡萄球菌的耐药性研究[J]. 中国病原生物学杂志, 2017, 12(2): 165-8.
[13] K rishnan PU, M files K, Shetty N. Detection ofm ethicillin and mupirocm resistance in Staphylococcus aureus isolates using conventional and molecular methods[J]. J Clin Pathol, 2002, 55(10): 745-9.
[14] Date SV, Modrusan Z, Lawrence M, et al. Global gene expression of methicillin-resistant Staphylococcus aureus USA 300 during human and mouse infection[J]. J Infect Dis, 2014, 209 (10): 1542-50.
[15] Van Hal SJ, Jensen SO, Vaska VL, et al. Predictors of mortality in Stuvhylococcus aureus bacteremia[J]. Clin Microbial Rev, 2012,26(2): 362-6.
[16] Till BG, Jensen MC, Wang J, et al. CD20-specific adoptive immunotherapy for lymphoma using a chimeric antigen receptor with both CD28 and 4-1 BB domains: pilot clinical trial results[J]. Blood, 2012, 119(117): 3940-50.
[17] Younes A, Gopal AK, Smith SE, et al. Results of a pivotal phase Ⅱ, study of brentuximab vedotin for patients with relapsed or refractory Hodgkin's lymphoma[J]. J Clin Oncol, 2012, 30(18): 2183-9.
[2] 张欣, 王洁, 艾丽梅. 783例淋巴瘤患者流行病学分析[J]. 现代预防医学, 2013, 40(20): 3908-12.
[3] Aoki R, Karube K, Sugita Y, et al. Distribution of malignant lymphoma in Japan: Analysis of 2260 cases, 2001-2006[J]. Pathol Int, 2008, 58(3): 174-82.
[4] Jaffe ES, Harris NL, Vardiman JW, et al. Hematopathology[M]. St. Louis:Elsevier,2011.
[5] Mani H, Jaffe ES. Hodgkin lymphoma: an update on its biology with new insights into classification[J]. Clin Lymphoma Myeloma, 2009, 9(3): 206-16.
[6] Lohr JG, Stojanov P, Lawrence MS, et al. Discovery and prioritization of somatic mutations in diffuse large B-cell lymphoma(DLBCL)by whole-exome sequencing[J]. Proc Natl Acad Sci USA, 2012, 109(10): 3879-84.
[7] Westin JR, Chu F, Zhang M, et al. Safety and activity of PD1 blockade by pidilizumab in combination with rituximab in patients with relapsed follicular lymphoma: a single group, open-label, phase 2 trial[J]. Lancet Oncol, 2014, 15(1): 69-77.
[8] Roman E, Smith AG. Epidemiology of lymphomas[J]. Histopathology, 2011, 58(1): 4-14.
[9] Feld R. Bloodstream infections in cancer patients with febrile neutropenia[J]. Int J Antimicrob Agents, 2008(32S): S30-S33.
[10] Michalska AD, Sacha PT, Ojdana D, et al. Carbapenem-resistant strains from the family Enterobacteriaceae isolated in the period 2006-2011 from clinical specimens of patients treated at the university hospital in northeastern Poland[J]. Med Dosw Mikrobiol, 2013, 65(1): 27-38.
[11] 付艳霞, 刘玉坤, 梁建红. 某医院产ESBLs大肠埃希菌感染及其耐药性研究[J]. 中国消毒学杂志, 2016, 33(1): 29-30, 33.
[12] 孟晶茜, 王建生, 赵瑛瑛, 等. 尿路感染分离金黄色葡萄球菌的耐药性研究[J]. 中国病原生物学杂志, 2017, 12(2): 165-8.
[13] K rishnan PU, M files K, Shetty N. Detection ofm ethicillin and mupirocm resistance in Staphylococcus aureus isolates using conventional and molecular methods[J]. J Clin Pathol, 2002, 55(10): 745-9.
[14] Date SV, Modrusan Z, Lawrence M, et al. Global gene expression of methicillin-resistant Staphylococcus aureus USA 300 during human and mouse infection[J]. J Infect Dis, 2014, 209 (10): 1542-50.
[15] Van Hal SJ, Jensen SO, Vaska VL, et al. Predictors of mortality in Stuvhylococcus aureus bacteremia[J]. Clin Microbial Rev, 2012,26(2): 362-6.
[16] Till BG, Jensen MC, Wang J, et al. CD20-specific adoptive immunotherapy for lymphoma using a chimeric antigen receptor with both CD28 and 4-1 BB domains: pilot clinical trial results[J]. Blood, 2012, 119(117): 3940-50.
[17] Younes A, Gopal AK, Smith SE, et al. Results of a pivotal phase Ⅱ, study of brentuximab vedotin for patients with relapsed or refractory Hodgkin's lymphoma[J]. J Clin Oncol, 2012, 30(18): 2183-9.