儿童急性白血病合并败血症56例分析

Analysis of 56 septicemia cases with pediatric acute leukemia patients after chemotherapy

目的探讨儿童急性白血病(AL)治疗中合并败血症的原因及治疗方法。方法 2011年1月至2014年7月入住安徽医科大学第二附属医院儿科的血培养阳性的AL患儿56例,分析其发病因素、病原学、耐药情况、治疗方法及疗效。结果 56例患儿中,急性淋巴细胞白血病32例,急性非淋巴细胞白血病22例,混合表型急性白血病(淋髓混合型)2例。常见感染途径依次是消化道、呼吸道、口腔,高发时间为诱导化疗阶段。中性粒细胞计数<0.5×109/L持续时间一周以上患儿败血症发生率显著升高。血培养病原菌以革兰阴性杆菌多见,前三位分别为大肠埃希氏菌、肺炎克雷伯杆菌、铜绿假单胞菌,其中产ESBL(超广谱β-内酰胺酶)大肠埃希氏菌9例(16%),产ESBL肺炎克雷伯杆菌2例(4%),对美罗培南、亚胺培南等碳青酶烯类药物均敏感。结论 AL患儿败血症的发生与化疗阶段、中性粒细胞缺乏时间等诸多因素相关。病原菌以革兰阴性杆菌多见,常见的感染途径为消化道和呼吸道。

Objective To explore the causes of septicemia in pediatric acute leukemia patients after chemotherapy and the method to decrease the mortality of septicemia. Methods Clinical data of fifty-six leukemia patients suffered from septicemia from January of 2011 to July of 2014 were analyzed.. Results Among all cases, 32 cases were acute lymphoblastic leukemia, 22 cases were acute myelocytic leukemia, 2 cases were mixed phenotype acute leukemia. Gastrointestinal tract,respiratory tract, and oral infection were the common positions of infection. The morbidity of patients with septicemia was high in introduction chemotherapy course. The risk factors of septicemia were level of granulocyte and duration of agranulocytosis. G- bacteria were the most common causes of infections ; Escherichia coli, Klebsiella and Pseudomonas aeruginosa accounted for the most of G- bacteria infections. ESBL-produeing strains of Escherichia coli and Klebsiella pneumoniae were 16% and 4%, respectively, and were susceptible to carbapenems, including imipenem and meropenem. Conclusions In patients with acute leukemia, the incidence of septicemia was related to the chemotherapy course, level of granulocyte and duration of agranulocytosis. G- bacteria were the most common causes of infection. Gastrointestinal tract and respiratory tract were the common positions of infection. Strengthening the care of gastrointestinal tract and respiratory tract in introduction chemotherapy course, G-CSF therapy can reduce the incidence of septicemia.