摘要
目的 了解实体肿瘤患者细菌感染情况。方法 回顾性分析本院2004年1月以来住院的化疗病人1906人次（636人，化疗1906次，PS=0～2，男475例，女161例，年龄58．2±18．8岁），对引起粒细胞减少Ⅱ～Ⅲ级，以及粒细胞减少合并发热（FN）的感染细菌进行分离，对其危险因素进行分析，并比较G—CSF对粒细胞粒细胞减少和FN的作用。晚期实体瘤细菌感染与死亡患者均为本科2003年1月至2005年12月住院病人共84例（女26例，年龄61±16岁，男58例，年龄60±16岁），对其死亡原因，感染部位，病原菌类型以及易感因素进行分析。结果 化疗后粒细胞减少发生率为28．1％，粒细胞减少并发热发生率为8．7％（165／1906），占粒细胞减少人群的36．3％，病原菌阳性检出率为9．7％，其中，导管尖／血培养1．1％，痰、尿等体液中培养的细菌检出率为7．6％，不明原因的FN占91．3％。引起粒细胞减少和FN与化疗方案有关，年龄大于65岁、化疗前白细胞低于5．0×10^6／L、化疗次数-9粒细胞减少、女性发生粒细胞减少的风险增加。粒细胞减少尽早使用G—CSF的FN发生率为10．8％（32／297），而晚用或未用G—CSF的FN发生率为18．3％（46／252），P=0．0123。应用G—CSF后，平均粒细胞减少持续5．45±0．15天，未用G—CSF者平均粒细胞减少8．20±0．52天，P〈0．0001。晚期实体瘤患者死亡因素中，感染发生率为35．70％，G^＋菌占7％，以MRSA和表皮葡萄球菌为主。G^-菌占8．30％，主要为大肠杆菌，克雷伯菌属和假单胞菌属。G^-／G^＋为0．6，混合感染占9．52％。各种耐药菌培养率占44．6％。原因不明感染者占10．90％。结论 老年人、女性、化疗前白细胞水平及化疗次数与化疗后白细胞减少均有关，早期使用GCS—F可使白细胞减少持续时间缩短并有预防FN的作用。恶性肿瘤晚期，以免疫缺陷导致�
Objective To evaluate the clinical characteristics, bacteria culture and risks of bacterial infection in patients with solid cancer, chemotherapy induced febrile neutropenia and death considered to be related to infectious complication were also analysed in those patients. Methods We retrospectively reviewed the clinical files of solid cancer patients who underwent chemotherapy in our department between January 2004 and December 2005. There are 636 patients, PS was 0-2, 475 males and 161 females, age ranged at 58.2 ± 18.8 years old. All 1906 times chemotherapy records available for analysis. From January 2003 to December 2004, 84 patients were died, 58 males with age at 60 ±16 years old and 26 females at age 61 ± 16 years old. In whom bacteria infection was analyzed. Results Chemotherapy induced neutropenia was 28.1% and febrile neutropenia rate was 8.7% （165/1906）. Pathogenic bacteria isolating rate was 9.7% （ catheter tip /blood culture 1.1%, sputum, urine , pleural effusion and ascites wasT. 6% ）. But unidentified FN had a rate of 90.3%. kogist multiple regression analysis show chemotherapy regime, older than 65 years old , leukocytes counts less than 5.0× 10^6/L, chemotherapy cycles and being female were risk of neutropenia and FN. FN were reduced significantly by using G- CSF earlier （10.8% vs18.3%）, P = 0.0123. Infection rate in patients who died from advanced cancer was 35.70%. In those patients, Granl positive bacteria isolating rate was 7 % （mainly were methicillin resistant staphylococcus aureus and staphylococcus epidermidis） and gram negative 8.30% （mainly were E coil, Klebsiella and Pseudomonas）. And polyinfection rate, various antibiotics- resistance bacteria and Cryptogenic infection were 9.52%, 44.6% and 10.90% respectively. Conclusion Pathogenic bacteria isolating rate was low in chemotherapy induced FN. Aged, female, leukocytes counts less than 5.0 × 10^6/L and chemotherapy cycles were risk of neutropenia and FN. Use of G- CSF can reduce FN rate. Infection in patients wi
出处
《癌症进展》
2006年第5期402-407,共6页
Oncology Progress
关键词
肿瘤
细菌感染
化疗
cancer bacterial infection chemotherapy
