Analysis Of Clinical Characteristics And Risk Factors Of Bloodstream Infection In Patients With Acute Leukemia

Objective:To study the clinical characteristics,pathogen characteristics,drug resistance and related risk factors of bloodstream infection in patients with acute leukemia after chemotherapy in our hospital,and to explore the influencing factors of prognosis and survival.Methods:The clinical data of 556 patients with acute leukemia admitted and treated in the hematology department of our hospital from January 1,2018 to December 31,2022 were analyzed retrospectively.The patients were divided into bloodstream infection group and non-bloodstream infection group.The clinical characteristics,flora distribution and drug resistance of patients with bloodstream infection after chemotherapy were analyzed.Usingχ~2test,univariate analysis and binary Logistic regression were used for multivariate analysis..59 patients with acute leukemia of bloodstream infection were followed up 60 days after the first positive blood culture.They were divided into survival group and death group,and the high risk factors affecting their prognosis and survival were analyzed.Results:There were 59 cases of bloodstream infection occurred in 556 patients with acute leukemia undergoing chemotherapy,the infection rate was 10.61%.A total of 59 strains of pathogenic bacteria were detected.Including 44 strains of Gram-negative bacteria(74.58%),and the highest detection rate of Escherichia coli was 35.60%.There were 15strains of Gram-positive bacteria(25.42%)and the highest detection rate of human staphylococci was 10.17%.One strain of fungus(1.69%)was Candida anonymously.Gram-negative bacteria were sensitive to carbapenem,but had high resistance to cephalosporins.Gram-positive bacteria were sensitive to vancomycin,fosfomycin and gentamicin,while high resistance to penicillins.Univariate analysis showed that the duration of hospital stay≥30 days,complicated with underlying disease,indwelling PICC catheter,white blood cell count≤0.5×10~9,neutropenia,duration of neutropenia≥7 days,chemotherapy cycle≥9 cycles and refractory recurrence stage were correlated with the occurrence of bloodstream infection.Multivariate analysis showed that duration of neutropenia≥7 days(OR=4.186,P=0.007)and associated underlying diseases(OR=2.388,P=0.000)were independent risk factors for bloodstream infection in patients with acute leukemia undergoing chemotherapy.Based on the further analysis of the prognosis of patients with bloodstream infection,it is concluded that the number of chemotherapy cycles≥9 cycles(P=0.001)and the use of glucocorticoids(P=0.003)are the high risk factors affecting the prognosis and survival of patients with acute leukemia bloodstream infection.Conclusion:The incidence of bloodstream infection in patients with acute leukemia was10.61%,and the mortality rate after bloodstream infection was 23.73%.Gram-negative bacteria are main pathogens causing bloodstream infection in acute leukemia patients after chemotherapy.And the infection is closely related to the underlying disease and the duration of neutropenia.The number of chemotherapy cycles and glucocorticoids are the factors affecting the prognosis and survival of patients with bloodstream infection.