Study On The Relationship Between Nutritional Status And Nosocomial Infection In Children With Acute Lymphoblastic Leukemia

Objective: To study the risk factors and infection characteristics of nosocomial infection in children with acute lymphoblastic leukemia and analyze the relationship between different nutritional status and infection and early treatment response.Methods: The clinical data of 133 children ALL treated with CCCG-ALL-2015 from June 2016 to June 2019(chemotherapy stage,risk level,MRD),infection during hospitalization(course of infection,laboratory indicators,use of antimicrobial agents and(or)antifungal drugs,sites of infection,referral)and nutritional status(gender,age,height/ length,weight)were collected.The Chi 2 test and Logistic Regression analysis were used for statistical analysis.Results:(1)Among 133 children with ALL(77 males,56 females),the ratio of males and females was 1.37:1;the median age was 4 years and 1 month in newly diagnosed;lower-risk group have 55 children,intermediate/high-risk group have 78 children;the ratio of B-ALL to T-ALL was 5.65:1.(2)During the treatment,there were 553 cases of infection(38.7%),284 cases of nosocomial infection(19.9%)and 3 cases of infection related death.Gender,immunophenotype and risk did not significantly affect the occurrence of nosocomial infection(P>0.05),but neutrophil count,hemoglobin,platelet count,chemotherapy stage,length of stay in hospital and nutritional status all affected the occurrence of nosocomial infection(P<0.05).Logistic multifactor regression analysis showed that chemotherapy stage,length of hospital stay,neutrophils and nutritional status were independent risk factors.(3)In 553 cases of infection,14% of them did not identify the infection site.Respiratory tract infection(61%)was the most common infection site.Skin soft tissue(2%)and urinary tract(1%)infection were rare.In blood culture,Gram-positive bacteria,Gram-negative bacteria and fungi accounted for 44.1%,52.9% and 2.9% respectively.The most common pathogens were Staphylococcus epidermidis,Klebsiella pneumoniae and Escherichia coli.The incidence of bloodstream infection was the highest in the induced remission period(58.8%).Malnutrition was an independent risk factor for bloodstream infection.(4)Among the133 children with ALL,6 were obese(4.5%),4 were overweight(3.0%),91 were well nourished(68.4%),and 32 were malnourished(24.1%).There were significant differences in the negative rates of D 19 and D 46 MRD between the groups with different nutritional status(P < 0.05).The incidence of malnutrition in the treatment stage was 28.6%.Conclusion:(1)Neutrophil count,chemotherapy stage,length of stay in hospital and nutritional status are independent risk factors of nosocomial infection.Nutritional status is negatively correlated with infection,and the worse the nutritional status is,the higher the risk of infection,especially blood flow infection.(2)Malnutrition and overweight and obesity can affect the early treatment response of ALL children.The level of nutrition at first diagnosis can be used as a bad factor to evaluate the early treatment response of ALL children.