急性白血病儿童化学治疗期间脓毒症病原学特点及危险因素

Pathogenic characteristics and risk factors of sepsis in children with acute leukemia during chemotherapy

目的了解急性白血病患儿住院化学治疗(化疗)期间医院感染并发脓毒症情况,探讨其病原学特点和危险因素。方法选取2021年1月—2022年6月某三级教学医院小儿内科819例急性白血病确诊患儿为研究对象。采用巢式病例对照研究方法,以监测期间出现脓毒症的患儿为病例组,按照1∶2的比例,随机选取同期住院且白血病类型相同的患儿为对照组。比较两组患儿基本资料及研究指标的差异,分析白血病化疗相关脓毒症危险因素,以及血标本病原体分布和药敏情况。结果819例急性白血病患儿中,发生脓毒症51例,发病率为6.23%。按照1∶2的比例配对,纳入102例患儿为对照组。血标本检出病原体29株,其中革兰阴性菌21株(72.41%),以大肠埃希菌为主;革兰阳性菌8株(27.59%),以缓征链球菌为主。使用糖皮质激素(OR=13.20,95%CI:3.42~155.81)、中性粒细胞绝对值<0.1×109/L(OR=38.09,95%CI:12.06~357.61)、血清清蛋白<35 g/L(OR=7.61,95%CI:2.11~39.76)为急性白血病化疗患儿发生脓毒症的独立危险因素(均P<0.05)。结论应加强急性白血病患儿化疗期间的感染监测、防控与随访,尤其对使用糖皮质激素、中性粒细胞绝对值和血清清蛋白水平较低的患儿,以减少医院感染并发脓毒症的发生。

Objective To investigate the occurrence of healthcare-associated infection(HAI)complicated with sepsis in hospitalized children with acute leukemia during chemotherapy,and explore its pathogenic characteristics and risk factors.Methods From January 2021 to June 2022,819 children who were diagnosed with acute leukemia in the pediatric department of a tertiary first-class hospital were selected as the study subjects.The nested case-control study method was adopted.Children with sepsis during the monitoring period were in the case group,and children with the same type of leukemia during the same hospitalization period were randomly selected as the control group based on 1∶2 ratio.Differences in basic information and research indicators between two groups of children were compared.Risk factors for sepsis related to leukemia chemotherapy,distribution and antimicrobial susceptibility of pathogens from blood specimens were analyzed.Results Among 819 children with acute leukemia,51 had sepsis,with an incidence of 6.23%.Paired in a 1∶2 ratio,102 children were included in the control group.29 strains of pathogens were isolated from blood specimens,including 21 strains(72.41%)of Gram-negative bacteria(mainly Escherichia coli)and 8 strains(27.59%)of Gram-positive bacteria(mainly Streptococcus midis).Use of glucocorticoids(OR=13.20,95%CI:3.42-155.81),absolute neutrophil count<0.1×109/L(OR=38.09,95%CI:12.06-357.61)and serum albumin<35 g/L(OR=7.61,95%CI:2.11-39.76)were independent risk factors for sepsis in children with acute leukemia during chemotherapy(all P<0.05).Conclusion It is necessary to strengthen the monitoring,prevention and control,and follow-up of the infection in children with acute leukemia during chemotherapy,especially for children who use glucocorticoids,with low absolute neutrophil count and low serum albumin level,so as to reduce the occurrence of HAI-associated-sepsis.