膀胱癌老年患者发生医院感染的病原菌种类及危险因素分析

发布时间：2018-04-01 13:30

本文选题：膀胱癌　切入点：医院感染　出处：《中华医院感染学杂志》2017年09期

【摘要】：目的探究老年患者膀胱癌术后发生医院感染的病原菌类型及危险因素,为临床诊治提供参考依据。方法选取于2011年7月-2016年7月医院收治的297例中老年膀胱癌患者为研究对象,收集发生医院感染的患者各项临床资料,并将感染患者切口分泌物送检,观察送检标本中病原菌分布及构成比,对可能引起感染的相关因素进行综合对比分析。结果 297例患者中,发生术后感染51例,感染率为17.17%;51例送检标本中,46例检测出病原菌,检出率为90.20%,共分离出病原菌47株,其中感染革兰阴性菌最多,32株占68.08%、革兰阳性菌10株占21.28%、真菌5株占10.64%;术后感染相关因素分析结果显示,老年膀胱癌患者术后发生医院感染与年龄、合并糖尿病、侵入性操作史、术前感染史、手术方式、手术进行时间以及术后使用抗菌药物等因素有关(P0.05),与患者性别、是否合并高血压以及住院时间长短无明显关系;多因素logistic分析显示,年龄较大、合并糖尿病、有侵入性操作史、有术前感染史、开腹手术、手术时间较长以及术后未使用抗菌药物治疗是术后发生医院感染的危险因素。结论老年膀胱癌患者术后发生医院感染的病原菌主要为大肠埃希菌、变形菌属和铜绿假单胞菌等革兰阴性菌;年龄较大、合并糖尿病、有侵入性操作史、有术前感染史、开腹手术、手术时间较长以及术后未使用抗菌药物治疗的患者术后更易发生医院感染。
[Abstract]:Objective to investigate the types and risk factors of nosocomial infection in elderly patients with bladder cancer, and to provide reference for clinical diagnosis and treatment.Methods 297 patients with bladder cancer were selected from July 2011 to July 2016. The clinical data of patients with nosocomial infection were collected, and the incisional secretions of infected patients were examined.The distribution and composition ratio of pathogenic bacteria were observed and the relative factors that might cause infection were compared and analyzed.Results among 297 patients, 51 cases had postoperative infection, and 46 of 51 specimens were detected, the detection rate was 90.20, and 47 strains were isolated.Among them, 32 Gram-negative bacteria accounted for 68.08, 10 Gram-positive bacteria accounted for 21.28 and 5 fungi accounted for 10.64.The results of post-operative infection analysis showed that the elderly patients with bladder cancer developed nosocomial infection and age, complicated with diabetes, and invasive operation history.The history of infection before operation, the way of operation, the time of operation and the use of antimicrobial agents after operation were related to the patients' sex, whether they were complicated with hypertension and the length of stay in hospital, and the multivariate logistic analysis showed that they were older.The risk factors of nosocomial infection were complicated with diabetes, history of invasive operation, history of infection before operation, open operation, long operation time and no use of antibiotics after operation.Conclusion the main pathogens of postoperative nosocomial infection in elderly patients with bladder cancer are Escherichia coli, Proteus, Pseudomonas aeruginosa and other gram-negative bacteria.Patients with open surgery, longer operation time and no antibiotics were more likely to develop nosocomial infection after operation.
【作者单位】：瑞安市人民医院泌尿外科;
【基金】：温州市科技局基金资助项目(Y20150215)
【分类号】：R737.14

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