Clinical Characteristics and Risk Factors of Nosocomial Infection in 472 Patients with Non-Hodgkin Lymphoma

Abstract

To investigate the clinical characteristics and risk factors of nosocomial infection in patients with non-Hodgkin lymphoma (NHL), in order to guide better clinical prevention and treatment of nosocomial infection. The incidence of nosocomial infection, infection site, characteristics of pathogenic bacteria, drug sensitivity test results and infection risk factors of 472 non-Hodgkin lymphoma patients admitted to the Second Affiliated Hospital of Fujian Medical University from January 2015 to September 2020 were retrospectively analyzed. Among the 472 patients, 97 (20.6%) had nosocomial infection, mainly in the lower respiratory tract (41.2%), followed by oral cavity, upper respiratory tract, urogenital tract, and blood. A total of 71 strains of pathogenic bacteria were isolated, including Gram-negative (G-) bacteria (52.1%), Gram-positive (G+) bacteria (28.2%), and fungi (19.7%). The detection rate of extended-spectrum β-lactamase (ESBLs) in Klebsiella pneumoniae and Escherichia coli was 36.4% and 22.2%, respectively. The resistance rate of Pseudomonas aeruginosa to carbapenems (imipenem) in G- bacteria was 33.3%, while the sensitivity rate of other G- bacteria was 100%. Among the 7 strains of Staphylococcus aureus, 1 strain was found to be methicillin-resistant Staphylococcus aureus (MRSA), and the sensitivity of G+ bacteria to linezolid, tigecyclinetegacycline and vancomycin was 100%. Candida albicans was the main source of fungal infection. Univariate analysis showed that nosocomial infection was associated with hospital day, bone marrow involvement, clinical stage, chemotherapy, neutrophil count in peripheral blood, and lymphoma type. Multivariable Logistic regression model showed that hospital days ≤7 was the protective factor of nosocomial infection, while clinical stage (Ⅲ, Ⅳ period), tumor involving bone marrow, and peripheral blood neutrophil count <0.5×109/L were major risk factors. NHL patients show high nosocomial infection rate and lower respiratory tract infection is common. Hospital day, clinical stage, presence of bone marrow invasion, and neutrophil count in peripheral blood are independent risk factors.