Hospital Acquired Pneumonia After Chemotherapy In Children With Acute Leukemia: A Clinical Analysis

Objective: In our country, hospital acquired pneumonia (HAP) is themost common type of nosocomial infection, have high morbidity andmortality. As for children with acute leukemia, its own development of theimmune system is still not perfect, meanwhile chemotherapy further destructsthe immune function, plus bone marrow suppression, absence of neutrophils,which result in higher morbidity and mortality and directly affect children'slives.It is pointed out that, in children with acute leukemia, onset is insidious,presenting few and not typical, in addition to fever and chest X rayabnormalities. Obviously, it is difficult to be diagnosed early and the cure maybe delayed. Therefore, carefully observation, early attention to risk factors forHAP infection, early recognition, early diagnosis, and early treatment areextremely necessary to reduce mortality.At home and abroad, as to acute leukemia patients during inpatienthospital acquired pneumonia in the patients, the study sample size on the riskfactors is small, most on adult or older patients. And most of them use singlefactor analysis method to analyze the risk factors. Only the initial screeningmay influence HAP risk factors, so it cannot exclude confounding factors. Sothe results may not be accurate. A multivariate Logistic regression analysis,from the overall perspective to describe quantitatively the size of each elementaction, overcome the one-sidedness of the single factor analysis.Therefore this article analyses66cases happening in5years in ourhospital. All of them are of hospital acquired pneumonia during chemotherapyfor children with acute leukemia, and may influence HAP risk factormultivariate Logistic regression analysis, so as to understand the clinical features and find related risk factors, and to seek better treatment scheme andprovide evidence for clinical prevention and treatment.Materials and Methods:1Choose Patients:There are206cases of children with acute leukemiaadmitted to our hospital paediatric haematology ward and completed a courseof chemotherapy were diagnosed by MICM from January2007to January2012.Among these206cases, there are142patients with acute lymphocyteleukemia,64cases are acute non lymphocytic leukemia. There were120malecases,86female cases, aged from0.5to14years old. The Median age is6years old, hospitalization time is15~79days, the average is37days. Amongthe cases,130cases are untreated or recurrent patients using induction ofremission, and76cases are palliation patients after the introduction ofmaintenance phase treatment. There are66cases are hospital-acquiredpneumonia,47cases of acute lymphocytic leukemia, and19cases are acutemyeloid leukemia,45of them with remission induction period, and11withmaintenance phase treatment.2Statistical Analysis:The factors related to hospital acquired Pneumonia wereevaluated using multivariate stepwise logistic regression analysis with SPSS13.0statistical program and a P-value less than0.05was considered to bestatistically significant.Results:1The Incidence rate of HAP: There were66cases of hospital acquiredpneumonia among the206cases of acute leukemia within5years, incidencerates are32.04%.2Clinical manifestations:Besides children with severe infection, the signs andsymptoms for other children are fever, and cough with or without sputum.There are10cases are presence of fine crackles upon auscultation, lesspositive factors. It also shows pulmonary infiltration change on theradiographic imagines.3There are71caltures of bacterial, only27cases were found. The incidencerates are38.03%, most of witch are pseudomonas aeruginosa. 4The treatment method and effect:"de-escalation" scheme, i.e. the initialempiric antimicrobial therapy combined with application may cover allpathogens, broad-spectrum antibiotics. Once acquired etiologic evidence, thissuper wide general treatment plan should be considered to change to a targeted,sensitive, relatively narrow spectrum antibiotic therapy. In this study after thetreatment of Meropenem add Norvancomycin for the66patients,47caseswere cured and9case with good effect. The total effective rate was84.85%.There are10death cases and the mortality rate is15.16%.5There are only three factors were found to be significant statisticaldifferences, such as neutropenia degree(P<0.00), neutropenia duration(P<0.04) and days of hospitalization (P<0.01).Conclusions:1The neutropenia degree and the duration of neutropenia in children withacute leukemia after chemotherapy are risk factors of hospital acquiredpneumonia.2Age, gender, type of leukemia, treatment phase and whether to apply ofhormone therapy on acute leukemia complicated with hospital acquiredpneumonia had no significant effect.3Whether hospitalization date is a risk factor for children with acute leukemiacomplicated with HAP are still remains to be further proof.4Early recognition, early diagnosis and early treatment, can improve the rateof hospital acquired pneumonia.5Taking the correct treatment for hospital acquired pneumonia in the initialempirical therapy, can reduce the mortality rate.