Clinical Diagnosis And Treatment Of Infection And Sepsis During Chemotherapy In Children With Acute Lymphoblastic Leukemia

Objective To analyze the incidence and treatment of infection and sepsis during chemotherapy in children with acute lymphoid leukemia(ALL)and provide reference for the prevention and treatment of infection.Methods The clinical data,risk factors,treatment and curative effect of infection and sepsis in 51 children with ALL who received chemotherapy for the first time from January 2015 to January 2018 in pediatric blood ward,affiliated Hospital of Southwest Medical University were analyzed retrospectively.Results The first diagnosis age of 51 children with ALL was 1~13(6.96±3.34)years,24males and 27 females.The infection rate of 464 patients in chemotherapy stage was 40.50%in terms of the number of courses of chemotherapy;the total infection rate was higher in high risk chemotherapy group(50.00%);the incidence of infection in the dangerous chemotherapy group was 80.60%,which was higher than that in the high risk chemotherapy group and the low risk chemotherapy group,respectively(X~2=6.034,P=0.015;X ~2=4.038,P=0.047),the difference is statistically significant.The incidence of infection in the high risk chemotherapy group was 57.80%,which was higher than that in the middle risk chemotherapy group and the low risk chemotherapy group(X~2=38.633,P<0.001;X ~2=8.690,P=0.003,P<0.05),the difference is statistically significant.The incidence of sepsis was 14.20%,and high incidence in the stage of induced remission therapy(X ~2=18.028;P=0.018).Pathogen infection is dominated by bacteria,followed by fungal infection,and there is also virus infection;In addition,there are also mixed infections,most of which are mixed infections of bacteria and fungi.Among the total infections,the upper respiratory tract infection was the most common in the primary infection site(32.40%),the second was pulmonary infection(28.70%),oral infection(7.40%),skin infection(7.40%),digestive tract infection(4.70%),perianal infection(4.20%)and suppurative tonsillitis(2.60%);the primary infection site of sepsis was pulmonary infection(24.20%).66 cases of sepsis were cultured with the positive rate of 15.15%;the detection rate of Gram-negative bacteria(G-bacteria)was high,for 70.00%;Klebsiella pneumoniae accounted for the most of Gram-negative bacteria(G-bacteria),for 57.10%,followed by Enterobacter tumefaciens,Escherichia coli and amikana.Neutrophil deficiency and granulocyte deficiency time are considered to be independent risk factors for sepsis in children with ALL;sepsis is more likely to occur when WBC<1.00x10~9/L and PLT<100.00x10~9/L;the sensitivity of G-bacteria to imipenem and meropenem was 100%,and that of G+bacteria to vancomycin and linazolamine was 100%.The cure rates of sepsis among different risk chemotherapy groups were 80.60%in high risk chemotherapy group,77.40%in middle risk chemotherapy group and 100%in low risk chemotherapy group,respectively,there was no significant difference in the cure rate of sepsis among the three groups(X~2=1.146,P=0.728).Conclusions The infection occurred higher in the high risk chemotherapy group and the induced remission stage;respiratory tract infection is the most common in both total infection and sepsis,and the primary infection site of sepsis is mainly in the lungs.Neutrophil deficiency and granulocyte deficiency time are independent risk factors for sepsis in children with ALL.The detection rate of G-bacteria was higher in blood culture,and Klebsiella pneumoniae accounted for the most of G-bacteria;the sensitivity of G-bacteria to imipenem and meropenem was100%,the sensitivity of G+bacteria to vancomycin and linazolamine was100%;the application of carbapenem antibiotics can improve the cure rate of sepsis relatively effectively.