儿童急性淋巴细胞白血病化疗后并发菌血症的影响因素分析

Influencing factors for bacteremia in children with acute lymphoblastic leukemia after chemotherapy

目的分析儿童急性淋巴细胞白血病(ALL)化疗后并发菌血症的影响因素。方法采用回顾性分析的方法,在无锡市儿童医院2013年8月-2017年1月接受化疗的全部ALL患儿中随机抽取454例样本为研究对象,记录患儿性别、年龄、病情危重分级、病原菌检出情况、病原菌菌株分布情况,进行影响因素的单因素和多因素分析。结果454例ALL患儿菌血症发生率为20.48%,化疗后共发生菌血症118次,男性占比高于女性,主要集中于1~10岁;高危(HR)患儿并发菌血症占比最高,且主要集中在诱导缓解与巩固治疗阶段,呼吸道是其主要感染部位;共检出病原菌41类,121株,其中革兰阳性菌检出株数最多;经单因素与Logistic回归分析结果显示,HR、长时间使用抗菌药物、中性粒细胞缺乏、中性粒细胞缺乏持续时间长、中心静脉置管、多种抗菌药物联合使用、耐药性高等可能是ALL患儿化疗后并发菌血症的影响因素(P<0.05)。结论儿童ALL化疗后常并发以呼吸道感染为主的菌血症,疾病的发生可能与化疗期间长时间中性粒细胞缺乏、中心静脉置管、多种抗菌药物使用、耐药性等因素有关,临床应密切关注ALL患儿化疗期间中性粒细胞表达变化情况,尽量减少抗菌药物的使用,减少中心静脉置管,以降低菌血症发生风险,提高化疗有效性与安全性,改善患儿预后。

OBJECTIVE To investigate the influencing factors for bacteremia in the children with acute lymphoblastic leukemia(ALL)after chemotherapy.METHODS By means of retrospective survey,a total of 454 children with ALL who received chemotherapy in Wuxi Children’s Hospital from Aug 2013 to Jan 2017 were randomly drawn as the study objects.The gender,age,severity of disease,isolation of pathogens and distribution of isolated pathogens were recorded,the influencing factors were found out,and univariate analysis and multirarite analysis were performed.RESULTS Among the 454 children with ALL,the incidence of bacteremia was 20.48%,totally 118 case times had bacteremia after chemotherapy,the male cases were more than the female cases,and the children aged between 1 and 10 years old were dominant.The proportion of the high-risk(HR)children who were complicated with bacteremia was the highest,most of whom had bacteremia during the remission induction and consolidation treatment stages,and the respiratory tract was the major infection site.Totally 121 strains of pathogens were isolated,involving 41 species,and the gram-positive bacteria were dominant.The results of univariate analysis and logistic regression analysis showed that HR,long term use of antibiotics,neutrophil deficiency,long duration of neutrophil deficiency,central venous catheter indwelling,combined use of multiple antibiotics and high drug resistance rate were the influencing factors for the bacteremia in the children with ALL after chemotherapy(P<0.05).CONCLUSION The children with respiratory tract infection is dominant among the children with ALL after chemotherapy,the emergence of the disease is associated with the long time of neutrophil deficiency,central venous catheter indwelling,use of multiple antibiotics and drug resistance.It is necessary for hospitals to focus on the level of neutrophils of the children with ALL during chemotherapy,try to use antibiotics as less as possible and avoid the central venous catheterization so as to reduce the risk of bacteremia,boost the effectiveness and safety of chemotherapy and improve the prognosis.