摘要
目的 回顾性分析老年非小细胞肺癌(non-small cell lung cancer,NSCLC)患者放化疗院内感染的病原菌构成及危险因素,以期为临床诊治提供参考。方法 回顾性分析多中心3家三级医院收治的老年NSCLC放化疗院内感染患者172例(作为观察组),选择同期来院放化疗但未发生院内感染的200例患者设为对照组。收集2组患者的一般资料及临床资料,得出患者感染的病原菌分布,采用单因素分析观察组患者感染的危险因素,再利用多因素Logistic回归分析对上述有差异的因素进行进一步分析。结果 观察组172例共检出188株病原菌,其中革兰氏阴性菌(Gram negative bacteria,G^(-))占多数,且以呼吸道感染为主。单因素分析显示,年龄、肿瘤分期(tumor node metastasis classification,TNM)、表面抗原分化簇4受体/表面抗原分化簇8受体(differentiation cluster 4 receptor/differentiation cluster 8 receptor,CD4+/CD8+)比值、中性粒细胞计数、预防性使用抗菌药物、应用激素、化疗周期及化疗方案是老年NSCLC放化疗患者并发院内感染的危险因素,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄≥75岁、肿瘤TNMⅢ-Ⅳ期、化疗周期数≥4、多药联用化疗方案、应用激素、 CD4+/CD8+<1.33及中性粒细胞数<1.0×10~9·L^(-1)是老年NSCLC患者放化疗期间医院感染的独立危险因素,差异均有统计学意义(P<0.05)。结论 老年NSCLC放化疗患者院内感染以G^(-)菌及呼吸道感染为主,且高危因素较多,包括年龄、肿瘤TNM分期、CD4+/CD8+比值、中性粒细胞计数、预防性使用抗菌药物、应用激素、化疗周期及化疗方案等,临床上需注意。
Objective To retrospectively analyze the pathogenic bacteria composition and risk factors of nosocomial infection caused by chemoradiotherapy in elderly patients with non-small cell lung cancer(NSCLC),therefore to provide a reference for clinical diagnosis and treatment.Methods A total of 172 elderly patients with nosocomial infection(as observation group)treated by chemoradiotherapy for NSCLC in 3 tertiary hospitals in multicenters were retrospectively analyzed,and 200 patients who visited the same period for chemoradiotherapy but did not develop nosocomial infection were selected as control group.The general data and clinical data of the 2 groups were collected to obtain the distribution of pathogenic bacteria of the patientsinfection,and the risk factors of the patientsinfection in the observation group were analyzed by univariate analysis,and the multivariate logistic regression analysis was used to further analyze the above factors with differences.Results A total of 188 pathogenic bacteria were detected in 172 patients in the observation group,of which Gram negative bacteria(G-bacteria)were the majority,and respiratory infections were the predominant.Univariate analysis showed that age,tumor node metastasis classification(TNM)stage,differentiation cluster 4 receptor/diferentiation cluster 8 receptor(CD4+/CD8+)ratio,neutrophil count,prophylactic use of antimicrobials,use of hormones,chemotherapy cycle,and chemotherapy regimen were risk factors for concurrent nosocomial infection in elderly patients undergoing chemoradiotherapy for NSCLC,with all significant differences(P<0.05).Multivariate logistic regression analysis showed that age≥75 years,TNM stageⅢ-Ⅳ,number of chemotherapy cycles≥4,multi-agent combination chemotherapy regimen,use of hormones,CD4+/CD8+<1.33,and neutrophil count<1.0×10^(9)·L^(-1) were independent risk factors for nosocomial infection during chemoradiotherapy in elderly patients with NSCLC,and all the differences were statistically significant(P<0.05).Conclusion The majority of nosocomial infections in elderly patients treated with chemoradiotherapy for NSCLC are due to G-bacteria and respiratory tract infections,and there are many high-risk factors,including age,tumor TNM stage,CD4+/CD8+ratio,neutrophil count,prophylactic use of antimicrobials,use of hormones,chemotherapy cycle and chemotherapy regimen,which are clinically noteworthy.
作者
刘翔
胡陶玉
李丹
LIU Xiang;HU Taoyu;LI Dan(Department of Medical Laboratory,Yibin Second People's Hospital,Yibin 644000,China;Department of Laboratory,Panzhihua Central Hospital,Panzhihua 641000,China)
出处
《西北药学杂志》
CAS
2023年第3期200-204,共5页
Northwest Pharmaceutical Journal
基金
攀枝花市科学技术局2020年度市级指导性科技计划项目(编号:2020ZD-S-26)。
