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目的调查分析局部晚期鼻咽癌行同步放化疗患者医院感染情况,探讨有效的防治措施。方法回顾性分析55例行同步放化疗鼻咽癌住院患者的医院感染病原体及药物敏感试验。结果 55例患者中发生医院感染38例,感染率为69.01%;医院感染出现的时间为放疗开始后10～49 d,中位时间为29.5 d;感染部位为口咽及鼻咽部黏膜36例,占94.73%,肺部1例,占2.63%,败血症1例,占2.63%;共分离病原菌47株及带状疱疹病毒1株,以革兰阴性菌最多见,共27株,占56.25%,其次为真菌,共18株,占37.50%;革兰阳性菌2株,占4.17%;革兰阴性菌耐药现象多见,主要对青霉素类、第一二代头孢类抗菌药物耐药;医院感染高危因素为口咽黏膜炎、白细胞减少、激素不合理使用。结论同期放化疗医院感染以革兰阴性菌口咽黏膜感染发生率最高,重视咽拭子培养及药敏检测,加强口腔护理、预防白细胞下降、合理应用糖皮质激素。
Objective To investigate and analyze the status of nosocomial infection in patients with locally advanced nasopharyngeal carcinoma treated with concurrent chemoradiotherapy and discuss the effective prevention and treatment measures. Methods Retrospective analysis of 55 patients with nosocomial infection of nasopharyngeal carcinoma in hospital concurrent chemoradiation and drug susceptibility testing. Results Among the 55 cases, 38 cases were nosocomial infection, the infection rate was 69.01%. The nosocomial infection occurred from 10 to 49 days after radiotherapy, with a median time of 29.5 days. The infection sites were 36 cases of oropharyngeal and nasopharyngeal mucosa , Accounting for 94.73%, lungs in 1 case, accounting for 2.63%, sepsis in 1 case, accounting for 2.63%; 47 pathogenic bacteria were isolated and a herpes zoster virus, the most common gram-negative bacteria, a total of 27 strains, accounting for 56.25% , Followed by fungi, a total of 18 strains, accounting for 37.50%; Gram-positive bacteria 2, accounting for 4.17%; Gram-negative bacteria more common, mainly penicillins, the first two generations of cephalosporins antimicrobial resistance; High-risk factors for nosocomial infection of oropharyngeal mucositis, leukopenia, hormone use unreasonable. Conclusions The incidence of oropharyngeal mucosal infection in Gram-negative bacteria is the highest in the hospital during the same period of radiotherapy and chemotherapy. Emphasis is placed on throat swab culture and drug susceptibility testing. Oral care is strengthened to prevent leukopenia and rational use of glucocorticoid is given.