评估三级医院癌症患者手术部位感染的抗菌素耐药性：一项前瞻性研究

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health Pub Date : 2025-06-18 DOI:10.1016/j.cegh.2025.102103

Vishala Kundarapu , Akshay Shelke , Pallavi Priya , Shiwani Mishra , Richa Chauhan , Sameer Dhingra

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引用次数: 0

摘要

手术部位感染（ssi）给癌症患者的治疗带来了巨大挑战，导致住院时间延长，发病率和死亡率增加。抗菌素耐药性（AMR）使治疗和恢复复杂化。本研究评估了癌症患者的SSI发生率、抗菌药物敏感性模式和临床结果。方法：这项前瞻性研究在印度比哈尔邦巴特那的Mahavir癌症研究中心招募了228名癌症患者，时间超过9个月，包括所有年龄的接受手术、发生ssi和接受抗菌治疗的患者。结果SSI发生率为7.8%，头颈部手术发生率最高（16.6%）。平均年龄46.77岁，男性占50.9%。48.01%的菌株存在多重耐药，主要病原菌为铜绿假单胞菌、大肠埃希菌和氧化克雷伯菌。对氟喹诺酮类药物和第三代头孢菌素耐药较高，而四环素和氨基糖苷类药物更有效。ssi患者的死亡率（33.9%）明显高于无ssi患者(3.0%；p & lt;0.05)。头颈癌手术死亡率最高（5.26%），胆囊手术死亡率最高（3.5%）。多因素分析发现，癌症（OR = 5.36, 95% CI: 1.56-18.42, p = 0.008）和放疗史（OR = 4.74, 95% CI: 1.13-19.76, p = 0.033）是死亡率的独立预测因素。结论肿瘤患者SSI发生率高，AMR显著。耐多药病原体和高死亡率强调迫切需要改善癌症治疗中的感染控制和抗微生物药物管理。局限性包括单中心设计、手术实践的潜在偏差和抗生素使用的可变性。

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Assessment of surgical site infections with antimicrobial resistance among cancer patients at a tertiary care hospital: A prospective study

Background

Surgical site infections (SSIs) significantly challenge cancer patients’ management, causing prolonged hospitalization, increased morbidity, and mortality. Antimicrobial resistance (AMR) complicates treatment and recovery. This study assessed the SSI incidence, antimicrobial sensitivity patterns, and clinical outcomes in cancer patients.

Methods

This prospective study enrolled 228 cancer patients over 9 months at Mahavir Cancer Sansthan and Research Center in Patna, Bihar, India, including patients of all ages who underwent surgery, developed SSIs, and received antimicrobial therapy.

Results

The study found an SSI incidence of 7.8 %, highest in head and neck surgeries (16.6 %). The average age was 46.77 years, with 50.9 % males. Multidrug resistance was found in 48.01 % of isolates, with Pseudomonas aeruginosa, Escherichia coli, and Klebsiella oxytoca as the main pathogens. High resistance to fluoroquinolones and third-generation cephalosporins was noted, while tetracycline and aminoglycosides were more effective. Mortality was significantly higher in patients with SSIs (33.9 %) compared to those without SSIs (3.0 %; p < 0.05). The highest mortality was observed in head and neck cancer surgeries (5.26 %) and gallbladder surgeries (3.5 %). Multivariate analysis identified carcinoma (OR = 5.36, 95 % CI: 1.56–18.42, p = 0.008) and history of radiation therapy (OR = 4.74, 95 % CI: 1.13–19.76, p = 0.033) as independent predictors of mortality.

Conclusion

This study reveals a high SSI incidence in cancer patients, with significant AMR. Multidrug-resistant pathogens and high mortality rates emphasize the urgent need for improved infection control and antimicrobial stewardship in cancer care. Limitations include the single-center design, potential biases from surgical practices, and antibiotic use variability.

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来源期刊

Clinical Epidemiology and Global Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

4.60

自引率

7.70%

发文量

218

审稿时长

66 days

期刊介绍： Clinical Epidemiology and Global Health (CEGH) is a multidisciplinary journal and it is published four times (March, June, September, December) a year. The mandate of CEGH is to promote articles on clinical epidemiology with focus on developing countries in the context of global health. We also accept articles from other countries. It publishes original research work across all disciplines of medicine and allied sciences, related to clinical epidemiology and global health. The journal publishes Original articles, Review articles, Evidence Summaries, Letters to the Editor. All articles published in CEGH are peer-reviewed and published online for immediate access and citation.