Analysis Of Infection In VDLP Induction Chemotherapy In Children With Acute Lymphoblastic Leukemia

ObjectiveTo analyze the infection of children with acute lymphoblastic leukemia(ALL)treated with CCCG-ALL2015 protocol during VDLP Induction Chemotherapy,to evaluate the incidence of infection,the site of infection,the risk factors of infection,the distribution of pathogens and drug sensitivity during induction chemotherapy.In order to strengthen infection monitoring and rational application of antibiotics,reduce the complications of chemotherapy-related infections,and provide the basis for ensuring the implementation of chemotherapy.MethodsA retrospective study was conducted medical records of 210 children with diagnosis of ALL was collected from January 2015 to July 2018 in the Children’s Medical Center of Qilu hospital of Shandong university.Statistical analysis of infection sites,risk factors,drug sensitivity,hospitalization costs,risk factors associated with infection,and prognostic factors..Results:1.General informationAmong 210 children with ALL,128 were males(61.0%)and 82 were females(39.0%)with a male-to-female ratio of 1.56:1;the average age was 5.5 years,and the median age was 4.8 years;191 cases of type B-ALL(91.0%),19 cases of type T-ALL(9.0%),and the ratio of type B-ALL to T-ALL was 10:1;164 cases(78.1%)were diagnosed with peripheral blood routine white blood cells less than 50×109/L,46 patients(21.9%)had white blood cell count greater than 50×109/L.The average white blood cell count at the time of initial diagnosis was 49.8 ×109/L and median was 8.5×109/L.There were 131 children in the standard-risk group,74 in the medium-risk group and 5 in the high-risk group.2.Incidence of infectionAmong 210 patients,111 cases were infected,the incidence of infections was 52.9%.A total of 148 infections episodes were recorded.Among 111 infected children,89 were single-site infections and 22 had multiple or multiple-site infections.3.Infection siteAmong the 148 cases of infection,41 cases(27.7%)were infected with unknown site;39 cases(26.3%)of the respiratory tract,and 27 cases(18.2%)of the oral cavity;blood infection 21 cases(14.2%);skin and soft tissue 8 cases(5.4%);intestinal 6 cases(4.1%);perianal 3 cases(2.0%);central system 2 cases(1.4%);urinary 1 case(0.7%).4.Distribution of pathogensA total of 31 pathogens were detected,including 17 Gram-positive bacteria(54.8%),11 Gram-negative bacteria(35.5%)and 3 fungi(9.7%).Gram-positive bacteria were Staphylococcus hominis(6 strains),Streptococcus aureus(5 strains),Staphylococcus epidermidis(2 strains),Enterococcus faecium(1 strain),Streptococcus sanguis(1 strain),Streptococcus oral(1 strain),Streptococcus salivarius(1 strain);Gram-negative bacteria were Pseudomonas aeruginosa(5 strains),Escherichia coli(2 strains),Enterobacter cloacae(2 strains)and scophthalmum(1 strain)and Stenotrophomonas maltophilia(1 strain);all three fungi were candida.5.Antibiotic resistance analysisGram-positive bacteria are sensitive to vancomycin and linezolid,and high sensitivity to levofloxacin,tetracycline and sulfamethoxazole,and high resistance to penicillin,erythromycin,clindamycin and ceftriaxone.Gram-negative bacteria had higher sensitivity to meropenem,imipenem,ceftazidime,cefepime,levofloxacin and amikacin,and higher resistance to amoxicillin and ceftriaxone.Fungi are sensitive to itraconazole,fluconazole,voriconazole,amphotericin B and flucytosine.6.Risk factors of infectionSingle factor χ2 test showed that infection was related to neutrophil deficiency time,hospitalization days and immunophenotype(P<0.05),but not to sex,age,risk,number of newly treated white blood cells(P>0.05).Multifactor logistic-regression analysis showed that the independent risk factors of infection were hospitalization days(OR=4.263),neutrophil deficiency time(OR=1.600),and immunophenotype(ORF=0.286).7.Hospitalization expensesThe average hospitalization cost of the infected group was 64298.52±23769.49 yuan.The average hospitalization cost for the non-infected group was 53462.69 yuan± 11736.53 yuan.Univariate analysis showed that the hospitalization cost of the infected group was higher than that of the non-infected group(P<0.001).8.Infection and prognosisIn VDLP Induction Chemotherapy,there were 3 deaths,all with severe infection,and the mortality rate of infection was 1.4%.Univariate analysis showed that there was no significant difference between infection and MRD on day 19 and 46(P>0.05).The log-rank test showed that there was no significant difference between infection and survival time(P>0.05).Conclusion1.Children with ALL have a high incidence of infection during VDLP Induction Chemotherapy.2.Infectious fever with unknown site is the main common infection site.The common infection sites are respiratory tract,oral,blood and skin.3.Gram-positive bacteria were the main pathogenic bacteria.The main Gram-positive bacteria were Staphylococcus hominis,Streptococcus aureus,Staphylococcus epidermidis.4.Hospitalization days and neutrophil deficiency time were risk factors for infection.5.VDLP Induction Chemotherapy of infection increases the cost of hospitalization for the child.