Risk Factors And Etiological Characteristics Of Sepsis And Septic Shock In Children With Leukemia

Objective:To investigate the risk factors and etiological characteristics of sepsis and septic shock in children with leukemia,and to provide reference for reducing sepsis and septic shock in children with leukemia.Method:A retrospective study was conducted to select some children diagnosed with leukemia who were hospitalized in Shengjing Hospital Affiliated to China Medical University from 2015 to 2022.They were divided into groups according to whether they developed sepsis or septic shock(septic shock group,sepsis group,and non-sepsis group).Basic information,laboratory results and treatment of all enrolled children were collected.The clinical features,risk factors and etiological characteristics of sepsis and septic shock in the above children were analyzed.Results:1.The fatality rate was 56.82%in the septic shock group and 5.39%in the sepsis group.There were statistical differences in gender,age,length of hospital stay,type of leukemia,risk grade,recurrence or not,neutrophil count,duration of neutrophil deficiency,hemoglobin,platelet,CRP,albumin,fungal results,virus and mycoplasma results,glucocorticoid use,broad-spectrum antibiotics use,indwelling gastric tube,catheter between the sepsis group and the non-sepsis group(P<0.05).There were statistical differences in age,length of hospital stay,risk grade,recurrence or not,neutrophil count,duration of neutrophil deficiency,hemoglobin,platelet,CRP,albumin,fungal results,virus and mycoplasma results,glucocorticoid use,broad-spectrum antibiotics use,mechanical ventilation,indwelling gastric tube,catheter between the septic shock group and the non-sepsis group(P<0.05).2.Analysis of risk factors:Age<1year or>10 years old,female,acute myelocytic leukemia and mixed acute leukemia,recurrence,platelet<10*10~9/L,CRP is elevated,hypoalbuminemia,virus and mycoplasma infection,glucocorticoid application,broad-spectrum antibiotics application>7 days of leukemia children were more likely to develop sepsis;Age<1or>10 years old,recurrence,platelet<10*10~9/L,hypoalbuminemia,glucocorticoid application of leukemia children were more likely to develop septic shock.3.Blood culture was the main source of positive culture of pathogenic microorganisms in sepsis group and septic shock group.Lower respiratory tract was the most common site of infection in sepsis group and septic shock group,while upper respiratory tract was the most common site of infection in non-sepsis group.4.Pathogenic microorganisms in sepsis group and septic shock group were mainly Gram-negative bacteria(Pseudomonas aeruginosa),and fungi were mainly candida;In the drug sensitivity test,there was no methicillin-resistant Staphylococcus aureus.There were 9 strains of Escherichia coli and Klebsiella pneumoniae producing ultra-broad spectrumβlactamase,and the highest sensitivity rates were imipenem and meropenem(100%).There were 6 strains of carbapenem-resistant enterobacter and carbapenem-resistant Pseudomonas aeruginosa,and the highest sensitivity rates were amicacin(83.33%).Conclusions:1.Septic shock in children with leukemia have a higher mortality rate.2.Reducing the use of non-essential glucocorticoids and broad-spectrum antibiotics are effective means to prevent sepsis and septic shock in children with leukemia.3.The pathogenic microorganisms of sepsis and septic shock leukemia were mainly Gram-negative bacteria,among which drug-resistant Gram-negative bacteria accounted for 36.59%.Relatively sensitive drugs should be selected as far as possible during empirical treatment.