老年急性髓系白血病患者化疗期间医院感染的危险因素及防治

目的对老年急性髓系白血病（AML）患者的院内感染情况进行分析,探讨其危险因素并提出相应的防治措施。方法收集本院2008至2012年收治的127例老年急性髓系白血病化疗住院患者的临床资料进行回顾性分析,并以同期非老年急性髓系白血病患者150例为对照组,比较两组患者的感染率和感染部位,并对AML组进行危险因素分层比较。结果 AML患者感染率为71.65%,显著高于对照组（35.33%）,差异具有统计学意义（χ^2=5.152,P〈0.05）;AML患者和对照组最易出现感染的部位均为呼吸系统,分别占38.46%和47.17%,其次为口腔和肠道,均占13%以上;两组患者呼吸系统、口腔以及肛周发生感染的比例差异具有统计学意义（P均〈0.05）,其他部位发生感染比例差异无统计学意义（P均〉0.05）;对91例感染者进行危险因素分析,结果显示疾病阶段、血清白蛋白、血红蛋白、白细胞数、中性粒细胞、住院时间、是否进行侵入治疗、有无肛周疾病、使用激素治疗及是否进行预防性抗菌药物使用与疾病发病密切相关（P均〈0.05）,均是该类患者发生院内感染的危险因素。结论老年AML患者是院内感染高发人群,对感染高危人群应进行针对性预防和护理,以减少感染的发生。

Risk factors of nosocomial infection for elderly patients with acute myeloid leukemia during chemotherapy and its prevention and control

Objective To analyze the nosocomial infections in elderly patients with acute myeloid leukemia（AML） and explore the risk factors and the corresponding control measures. Methods The clinical data of 127 hospitalized AML patients with chemotherapy in our hospital from 2008 to 2012 were analyzed, retrospectively; while the same period of 150 non-elderly patients with AML were taken as the control group. The infection rates and infection sites in the two groups were compared, respectively. The risk factors for the AML group were also performed. Results AML patients with the infection rate was 71.65%, significantly higher than the control group（35.33%）（χ^2 = 5.152, P 〈0.05）. AML patients and the control group most prone the sites of infection were the respiratory system, accounting for 38.46% and 47.17%, respectively, followed by oral and intestinal tract, both account for more than 13%. The infection ratio of respiratory, oral and anal were with significant difference（P all 〈0.05）, the infection ratio of other parts were with no significant difference（P all 〉0.05）. The infection risk factor analysis of 91 cases showed that disease stage, serum albumin, hemoglobin, white blood cell count, neutrophil, length of stay, whether invasive treatment, with or without perianal disease, use of steroids therapy and whether use of prophylactic antimicrobial drug were closely associated with disease onset（P all 〈0.05）, and above all were risk factors of nosocomial infection in these patients. Conclusions AML is the high risk population of hospital infection. The infection of high-risk groups should be targeted prevention and care, to reduce the incidence of infection.