本文選題：膀胱癌　切入點(diǎn)：醫(yī)院感染　出處：《中華醫(yī)院感染學(xué)雜志》2017年09期

【摘要】：目的探究老年患者膀胱癌術(shù)后發(fā)生醫(yī)院感染的病原菌類(lèi)型及危險(xiǎn)因素,為臨床診治提供參考依據(jù)。方法選取于2011年7月-2016年7月醫(yī)院收治的297例中老年膀胱癌患者為研究對(duì)象,收集發(fā)生醫(yī)院感染的患者各項(xiàng)臨床資料,并將感染患者切口分泌物送檢,觀察送檢標(biāo)本中病原菌分布及構(gòu)成比,對(duì)可能引起感染的相關(guān)因素進(jìn)行綜合對(duì)比分析。結(jié)果 297例患者中,發(fā)生術(shù)后感染51例,感染率為17.17%;51例送檢標(biāo)本中,46例檢測(cè)出病原菌,檢出率為90.20%,共分離出病原菌47株,其中感染革蘭陰性菌最多,32株占68.08%、革蘭陽(yáng)性菌10株占21.28%、真菌5株占10.64%;術(shù)后感染相關(guān)因素分析結(jié)果顯示,老年膀胱癌患者術(shù)后發(fā)生醫(yī)院感染與年齡、合并糖尿病、侵入性操作史、術(shù)前感染史、手術(shù)方式、手術(shù)進(jìn)行時(shí)間以及術(shù)后使用抗菌藥物等因素有關(guān)(P0.05),與患者性別、是否合并高血壓以及住院時(shí)間長(zhǎng)短無(wú)明顯關(guān)系;多因素logistic分析顯示,年齡較大、合并糖尿病、有侵入性操作史、有術(shù)前感染史、開(kāi)腹手術(shù)、手術(shù)時(shí)間較長(zhǎng)以及術(shù)后未使用抗菌藥物治療是術(shù)后發(fā)生醫(yī)院感染的危險(xiǎn)因素。結(jié)論老年膀胱癌患者術(shù)后發(fā)生醫(yī)院感染的病原菌主要為大腸埃希菌、變形菌屬和銅綠假單胞菌等革蘭陰性菌;年齡較大、合并糖尿病、有侵入性操作史、有術(shù)前感染史、開(kāi)腹手術(shù)、手術(shù)時(shí)間較長(zhǎng)以及術(shù)后未使用抗菌藥物治療的患者術(shù)后更易發(fā)生醫(yī)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.
【作者單位】： 瑞安市人民醫(yī)院泌尿外科;
【基金】：溫州市科技局基金資助項(xiàng)目(Y20150215)
【分類(lèi)號(hào)】：R737.14

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