| ObjectiveTo investigate the characteristics of nosocomial infection in patients with B-cell type non-Hodgkin’s lymphoma after chemotherapy,analyzes the risk factors for nosocomial infection,to guide the clinic to better prevent hospital infections.Materials and MethodsThe retrospective cohort methods was used to analyze the information of 274patients after chemotherapy with B-NHL lymphoma from November 2013 to March 2019 in our hospital.The incidence,Infection site,fungal infection,bloodstream infection and susceptible factors of infectious complications were analyzed.All data in this study were analyzed by chi-square test,single factor logistic-regression analysis and multivariate logistic-regression analysis using SPSS 18.0.Results1.A total of 63 cases of infection occurred in 274 cases of chemotherapy,the incidence of nosocomial infections was 23.0%;Patients may have multiple infections or different parts of infections during chemotherapy,there are 81 cases according to the infection site,73 cases of which with clear infection site and 8cases with unclear infection site.Among 81 cases of infection according to infection site,35 cases of pulmonary infection,accounting for 43.2%;7 cases of upper respiratory tract infection,accounting for 8.6%;2 cases of bronchitis,accounting for 2.5%;13 cases of bloodstream infection,accounting for 16.0%;skin infections in 4 cases,accounting for 4.9%;oral infections in 7 cases,accounting for8.6%;peritonitis in 2 cases,accounting for 2.5%;urinary tract infections in 2 cases,accounting for 2.5%;perianal infections 1 Case,accounted for 1.2%;8 cases of uninfected infection,accounting for 10%.2.There were 11 cases of fungal infection in 274 cases of chemotherapy.The incidence of fungal infection was 4.0%(11/274).Only 1 case was confirmed by fungal culture.10 cases were diagnosed by clinical manifestation and which got well after antifungal therapy,the positive detection rate of fungal culture was low,only 9.1%(1/11).The site of fungal infection was mainly oral infection and pulmonary infection.3.The incidence of sepsis was 4.7%,and the primary infection site was mainly pulmonary infection,accounting for 61.5%.The positive results of blood culture in13 cases were mainly Gram-negative bacteria,accounting for 84.6%,including escherichia coli and klebsiella pneumoniae,respectively accounting for about27.3%,followed by pseudomonas aeruginosa and pantoea agglomerans,accounting for about 18.2%respectively.Gram-negative bacteria have high sensitivity to carbapenem antibiotics,was 100%,followed by semi-synthetic penicillin antibiotics with enzymes,and highest resistance rates to otherβ-lactam antibiotics.There were only 2 cases(staphylococcus aureus and pharyngeal streptococcus)of Gram-positive bacteria among the positive results of blood culture,accounting for18.2%.Two strains of Gram-positive bacteria have high sensitivity to teicoplanin,vancomycin and linezolid,both were 100%.4.The single factor analyzed results show that the nosocomial infection were related to hospitalization days,lymphoma types,whether the tumor affects the bone marrow,whether the tumor originating from the gastrointestinal tract,clinical stage and the number of peripheral blood neutrophils after chemotherapy.Multivariate logistic regression analysis showed that hospitalization days≤7 days(OR=0.088,P=0.0289)is a protective factor for nosocomial infection in patients with B-cell NHL after chemotherapy,the tumor not originating from the gastrointestinal tract(OR=4.742,P=0.0273),and the number of peripheral blood neutrophils<0.5×10~9/L(OR=68.643,P=0.0007)after chemotherapy were the independent risk factor for nosocomial infection in patients with B-NHL chemotherapy.Conclusion1.The incidence of nosocomial infection in patients with B-cell type NHL is high.The most common site of infection is the lungs,followed by blood and oral cavity.The pathogens are mainly Gram-negative bacteria.The antibiotic mainly against gram-negative bacteria should be the first choice for empirical anti-infective treatment.2.The positive detection rate of fungal infection is low.Considering common fungal infections with granulocyte-deficient patients,Therefore empirical antifungal treatment was great important.Empirical antifungal treatment was necessary for those who with ineffective treatment of broad-spectrum antibiotics.3.The drug-resistant gram-negative bacteria have the highest sensitivity to carbapenems antibiotics,and are generally resistant to otherβ-lactam antibiotics such as cephalosporins,semi-synthetic penicillins and Monamide ring antibiotics.4.The hospitalization days,the number of peripheral blood neutrophils and whether the tumor originating from the gastrointestinal tract were the independent risk factors for nosocomial infection in patients with B-NHL after chemotherapy. |
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