Etiology Of Fever During Bone Marrow Suppression Period After Chemotherapy In Children With Acute Leukemia

Background Acute leukemia(AL)has the highest incidence in childhood malignancies.The survival and remission rate of AL increased greatly with the improvement of medical technology.However,new chemotherapy regimens has a longer course of treatment and are more intense compared to previous ones.Chemotherapeutic drugs cause complications including bone marrow suppression followed by infection whicle they kill tumor cells.Clinical manifestations are not obvious in early infection in the bone marrow suppression period and fever may be the only symptom.Identifying pathogens in the early stage of fever can provide information for early experiential treatment.Objective To Analyze pathogens of fever in bone marrow suppression period post chemotherapy in children with acute leukemia in our hospital,understand the causes of fever and pathogen`s distribution and analyze the risk factors,so as to provide reference for early experiential treatment.Methods 51 children were diagnosed with leukemia and received chemotherapy from December 2015 to December 2016 in pediatric ward of Ningxia Medical University General Hospital.A total of 361 events of bone marrow suppression occurred during or post chemotherapy,among whom 217 had fever.Blood or bone marrow culture,procalcitonin(PCT),C reactive protein(CRP)and corresponding pathogen were tested before administration of antibiotics except those cases of drug reaction.The causes,pathogens and risk factors of fever such as age,sex,degree of bone marrow suppression(neutrophil reduction)were analyzed statistically for all cases of fever.Results1.The fever rate was 60% in bone marrow suppression period of AL.Respiratory infectionwas the leading cause(fever rate 41.5%),followed by neutrophilic(4.5%),gastrointestinal tract infection(4.2%)and septicemia(2.0%).2.36 strains of pathogens were detected and the isolating rate was 19.3%.3.Fever was statistically affected by age and degree of bone marrow suppression,not gender.Conclusion1.Fever rate is 60% in bone marrow suppression period due to AL chemotherapy,among which 11.2% is non infection and 88.8 is infection.The risk of infection is very high during bone marrow suppression period.2.Respiratory tract infection is the leading cause of fever in bone marrow suppression due to AL chemotherapy,followed by neutropenic fever,gastrointestinal tract infection,septicemia and drug reactions.3.The isolating rate was low to 19.3% in the fever in bone marrow suppression period due to AL chemotherapy,among which 80.1% was bacterial infection,mainly Gram-negative bacteria(52.8%),followed by Gram-positive bacteria(27.8%).4.The degree of bone marrow suppression was closely related with fever in bone marrow suppression due to chemotherapy.The severer the bone marrow suppression,the higher the rate of fever.5.The degree of bone marrow suppression is closely related with positive rate of infection markers.The severer the bone marrow suppression,the higher the positive rate of infection markers is.PCT value was significantly higher in 10 cases with septicemia,and its positive rate is high in infectious fever.