Clinical Characteristic Of 143 Bacteremia Episodes With Pediatric Acute Lymphoblastic Leukemia Patients After Chemotherapy

Objective:To investigate the etiological characteristics and clinical manifestations of the pediatric acute lymphoblastic leukemia(ALL) patients with bacteremia in an effort to provide scientific evidence for clinical empirical use of antibiotics.Methods:1.Total 143 bacteremia episodes occurred in 112 of 545 pediatric acute lymphoblastic leukemia patients were analyzed since April, 2008 to December, 2014. And the clinical manifestations, morbidity, timing of bacteremia, site of infection, etiological characteristics, drug susceptibility rates, related factors for bacteremia, treatment and outcomes were retrospectively analyzed.2.Etiological characteristics and drug susceptibility rates: Bacteria identification system and fully automatic blood culture instrument were produced by BD company in the United States. Strictly in accordance with The minimum bacteriostasis concentration method(MIC) and the 2012 Clinical and Laboratory Standards Institute standards of the American for drug sensitive test.3.Statistical Analysis:By using SPSS19.0 software to analysed the data; Chi-square was used to compare difference in Rate or constituent ratio; Linear correlation was used to identify the relationship between the two variables; Other statistical methods and statistical indicators included mean, median, percentage, frequency.Results:1.The morbidity of 545 pediatric ALL with bacteremia was 20.55%.2.The patients with onset of bacteremia was most during the induction course in chemotherapy.3.Respiratory tract, gastrointestinal tract were the most common positions with infection onset.4.Among 147 strains pathogens isolated from the patients. Gram-positive bacteria contribute the 52.38%(77/147) strains while 70 strains(47.62%) were Gram-negative bacteria, which implied the Gram-positive bacteria as the most common causes of infection.The Staphylococcus epidermidis(18.37%), Escherichia coli(17.69%), Staphylococcus hominis(9.52%) ranked the top three species.5.The Gram-positive bacteria were highly susceptible to Vancomycin, Linezolid, teicoplanin; and the Gram-negative bacteria were highly susceptible to meropenem, Imipenem.6.The incidence rate of bacteremia was significantly increased with the neutrophil count below 0.5×109/L and the duration of neutropenia more than 7 days(P<0.001), the High-risk ALL groups and central venous cathete(P<0.05). The incidence rate of bacteremia had no difference in gender(P>0.05).7.The total effective rate of 143 bacteremia episodes was 95.10%(136/143). Most of the treatment with one antibacterial drug was effective. Total 7 death cases occurred in 112 of 545 pediatric acute lymphoblastic leukemia patients, with the incidence of bacteremia-related mortality 1.28%.Conclusion:1.Bacteremia is one of the major complication and cause of mortality during chemotherapy for ALL.2.Respiratory tract and gastrointestinal tract are the most common positions of infection.3.Among the pathogens, the detection rate of the Gram-positive bacteria is higher than that of the Gram-negative bacteria.4.In patients with the pediatric ALL, the incidence of bacteremia is relevant to the chemotherapy course, level of granulocyte, duration of agranulocytosis, risk stratification of ALL and so on.5.Most of the treatment with one antibacterial drug was effective.