恶性肿瘤患者医院内败血症的临床和病原菌耐药分析

目的探讨恶性肿瘤患者医院内败血症的临床特点、常见病原菌及耐药情况,指导临床诊断和治疗。方法回顾性分析温州医学院附属第一医院2005年9月~2007年10月恶性肿瘤合并医院内败血症的70例病例。结果全部病例均有发热,血液恶性肿瘤组≥40℃有19例,非血液恶性肿瘤组仅5例,两组比较差异有统计学意义(χ2=10.145,P0.01)。71株病原菌中革兰阴性菌占46.5%,革兰阳性菌占35.2%,真菌占18.3%。对革兰阴性菌敏感性较高的有碳青霉烯类、哌拉西林/他唑巴坦和头孢哌酮/舒巴坦;对革兰阳性菌敏感性较高的是万古霉素和替考拉宁。70例患者使用抗菌药物的治疗时间为1~49 d,平均(29.1±23.6)d。全组病例恶化及病死率为14.3%。结论恶性肿瘤患者医院内败血症严重影响预后,临床应高度重视,及时选用敏感抗菌药物治疗。

Clinical characteristics and drug resistance of nosocomial septicemia in patients with malignant tumors

Objective To investigate the clinical characteristics,etiologic distribution and drug resistance of nosocomial septicemia in patients with malignant tumors.Methods Seventy cases of nosocomial septicemia were collected from September,2005 to October,2007.Results Fever was developed in all of the patients,among which fever with more than 40℃ was found in 19 patients of hematological malignancies and in 5 patients of other tumors（χ2=10.145,P0.01）.Gram negative bacteria were isolated in most of the patients（46.5%）,followed by Gram positive bacteria（35.2%） and fungi（18.3%）.The Gram negative bacteria were more sensitive to carbopenem antibiotics,piperacillin/tazobactam and cefoperazone/sulbactam,while Gram positive bacteria were more sensitive to vancomycin and teicoplanin.The time of antibiotic therapy ranged from 1 to 49 days with an average of 29.1±23.6 days.The rate of mortality was 14.3%.Conclusion Nosocomial septicemia was a serious problem in patients with malignant tumors.Antibiotics for the therapy of septicemia should be used under the guidance of antibiotic susceptibility testing.