急性淋巴细胞白血病化疗患儿发生菌血症的影响因素

Influencing factors of bacteremia in children with acute lymphoblastic leukemia undergoing chemotherapy

目的:探讨急性淋巴细胞白血病(ALL)化疗患儿发生菌血症的影响因素。方法:回顾性分析2019年1月至2020年12月该院收治的60例化疗期间发生菌血症的ALL患儿的临床资料,设为发生组;另收集同期收治的100例化疗期间未发生菌血症的ALL患儿的临床资料,设为未发生组。收集两组患儿相关病历资料,采用单因素和多因素Logistic回归分析ALL化疗患儿发生菌血症的影响因素。结果:两组性别、年龄及电解质紊乱占比比较,差异均无统计学意义(P>0.05);发生组白细胞计数≥2×10^(9)/L、化疗次数≥3次、穿刺次数≥3次、未预防性使用抗菌药物、使用糖皮质药物、中性粒细胞缺乏持续时间≥7 d、置管时间≥3 d、抗菌药物使用时间>7 d、三联抗菌药物、抗菌药物耐药占比均高于未发生组,差异有统计学意义(P<0.05);Logistic回归分析结果显示,穿刺次数≥3次、使用糖皮质药物、中性粒细胞缺乏持续时间≥7 d、化疗次数≥3次、置管时间≥3 d、抗菌药物耐药、抗菌药物使用时间>7 d、三联抗菌药物均为影响ALL化疗患儿发生菌血症的危险因素(OR>1,P<0.05),白细胞计数≥2×10^(9)/L、预防性使用抗菌药物均为影响ALL化疗患儿发生菌血症的保护因素(OR<1,P<0.05)。结论:穿刺次数≥3次、使用糖皮质药物、中性粒细胞缺乏持续时间≥7 d、化疗次数≥3次、置管时间≥3 d、抗菌药物耐药、抗菌药物使用时间>7 d、三联抗菌药物均为影响ALL化疗患儿发生菌血症的危险因素,白细胞计数≥2×10^(9)/L、预防性使用抗菌药物均为影响ALL化疗患儿发生菌血症的保护因素。

Objective:To investigate influencing factors of bacteremia in children with acute lymphoblastic leukemia(ALL)undergoing chemotherapy.Methods:The clinical data of 60 ALL children with bacteremia during chemotherapy admitted to this hospital from January 2019 to December 2020 were retrospectively analyzed and they were set as occurrence group;the clinical data of 100 children with ALL who did not develop bacteremia during chemotherapy were collected and they were chosen as non-occurrence group.The relevant medical records of the two groups were collected.Univariate and multivariate Logistic regression analysis were used to analyze the influencing factors of bacteremia in the children with ALL undergoing chemotherapy.Results:There were no statistically significant differences in gender,age,and proportion of electrolyte disorders between the two groups(P>0.05).The proportions of white blood cell count≥2×10^(9)/L,number of chemotherapy≥3 times,number of punctures≥3 times,no prophylactic use of antibiotics,use of glucocorticoids,duration of neutropenia≥7 d,catheterization time≥3 d,use time of antibiotics>7 d,triple antibiotics,and antibiotic resistance in the occurrence group were higher than those in the non-occurrence group,and the differences were statistically significant(P<0.05).Logistic regression analysis showed that the number of punctures≥3 times,the use of glucocorticoid drugs,the duration of neutropenia≥7 d,the number of chemotherapy≥3 times,the catheterization time≥3 d,the resistance of antibiotics,the use of antibiotics>7 d,and triple antibiotics were all risk factors for bacteremia in the children with ALL undergoing chemotherapy(OR>1,P<0.05),while white blood cell count≥2×10^(9)/L and prophylactic use of antibiotics were the protective factors(OR<1,P<0.05).Conclusions:The number of punctures≥3 times,the use of glucocorticoid drugs,the duration of neutropenia≥7 d,the number of chemotherapy≥3 times,the catheterization time≥3 d,the resistance of antibiotics,the use of antibiotics>7 d,and triple antibiotics are the risk factors for bacteremia in the children with ALL undergoing chemotherapy,while white blood cell count≥2×10^(9)/L and prophylactic use of antibiotics are the protective factors.