肿瘤重症患者合并血液感染后死亡的相关危险因素分析

  目的  分析重症监护病房肿瘤患者血液感染菌谱并对其相关危险因子进行研究评价。  方法  回顾性分析2010年1月至2011年6月期间天津医科大学附属肿瘤医院合并血液感染的重症肿瘤患者临床资料。  结果  88例患者发生了血液感染, 男性56例, 女性32例, 平均（65.8±24.2）岁。45例生存, 43例死亡。血液感染常见菌是凝固酶阴性葡萄球菌42株（37.8%）、大肠埃希氏菌15株（13.5%）以及白假丝酵母菌9株（8.1%）。单变量分析显示机械通气>7 d、中心静脉插管以及较高的APACHE Ⅱ评分是重症肿瘤患者合并血液感染后死亡的重要危险因子, 其中机械通气>7 d为独立的死亡风险因子（OR=6.8, 95%CI: 2.5~18.4, P < 0.001）。  结论  凝固酶阴性葡萄球菌是引起肿瘤患者血液感染的主要病原菌, 临床应据此采取相应的预防控制措施, 以减少重症肿瘤患者血液感染的发生发展。 

Risk Factor Analysis of Mortality Following Bloodstream Infections of Cancer Patients in Intensive Care Unit

  Objective  The present study aims to analyze the bloodstream infection profiles and assess the risk factors associated with mortality of cancer patients in the intensive care unit (ICU) with bloodstream infections.  Methods  Medical records of cancer patients with bloodstream infections, admitted to the Tianjin Medical University Cancer Institute and Hospital during January 2010 and June 2011, were retrospectively analyzed.  Results  Microbiological data of 88 cases with bloodstream infections were recorded in our study (56 males, 32 females; 65.8 ±24.2 years old). Of the total patients, 45 survived and 43 died. The most commonly seen etiological agents of bloodstream infections were coagulase-negative staphylococci in 42 cases (37.8%), Escherichia coli in 15 cases (13.5%), and Candida albicans in 9 cases (8.1%). Univariate analysis showed that risk factors included mechanical ventilation for more than 7 days and duration of central venous catheterization and higher APACHE Ⅱ scores, of which, mechanical ventilation of more than 7 days was the independent mortality risk factor (odds ratio: 6.8, 95%; CI: 2.5–18.4; P < 0.001).  Conclusion  Bloodstream infections caused by coagulase-negative staphylococci are the major source of mortality in severe tumor cases. Prevention and treatment of bloodstream infections should mainly focus on preventing infections caused by coagulase-negative staphylococci in cancer patients in the ICU.