| BackgroundAcute leukemia is the most common malignancy in children.Infection is the most common complication after treatment in children with acute leukemia.Among them,bloodstream infections have an acute onset,rapid progress,and severe symptoms,which play an important role in the study of infection in children with acute leukemia.The problem of drug resistance of pathogens has become increasingly severe.Once a bloodstream infection of multidrug-resistant bacteria occurs,the child has a poor prognosis.Therefore,to summarize the clinical characteristics and high risk factors of bloodstream infection of multidrug-resistant bacteria,regular review of local major pathogens and drug resistance can help guide clinical prevention,identification and treatment of bloodstream infection of multidrug-resistant bacteria,improve the prognosis of children.Objective1.To summarize the clinical characteristics of bloodstream infection of multidrug-resistant bacteria in children with acute leukemia and analyze its high risk factors.2.Review the composition of the bloodstream infection in children with acute leukemia in this center,and analyze the composition of multidrug-resistant bacteria.Methods1.Collection of patientsThrough the retrieval of the Jiahe electronic medical record system,cases of acute leukemia complicated with bloodstream infections admitted to our department from January 2013 to September 2018 and regularly followed up were collected,and appropriate cases were selected according to the inclusion criteria.After being determined as the enrolled case,the age,sex,type of primary blood disease,stage of chemotherapy,duration of neutropenia,co-infection,blood routine,inflammation index,fever duration,treatment method,course of treatment,prognosis,etc.were collected.2.Group objectsAccording to the article,Children with acute leukemia who were eligible for multidrug-resistant,extensively drug-resistant and pandrug-resistant bacteria were enrolled in the multidrug-resistant group,and the remaining children were divided into non-multidrug-resistant groups.3.Grades of efficacyAccording to the ECIL-4,Within 48 hours after application of antibacterial drugs,improvement of clinical symptoms(including but not limited to stable hemodynamic recovery,disappearance or improvement of fever symptoms,disappearance or improvement of original infection symptoms,etc.)came.Those who do not meet the valid definition are defined as invalid.4.Data analysis methodsSPSS 20.0 software was used for statistical analysis.Measurement data were expressed as meantSD(x ± s),and t test was used for the comparison of inter-group difference;enumeration data were expressed as number of cases(n)and percentage[n(%)]5 and chi-squared test or Fisher's exact test was used for the comparison of inter-group difference.P<0.05 was considered statistically significant.Result1.General informationA total of 121 children were enrolled in the study,The male to female ratio was 1.47:1 and the average age was 5.9 years.There were 55 cases in the multidrug-resistant group,with a male to female ratio of 1.62:1 and an average age of 5.6 years.There were 66 cases in the non-multidrug-resistant group,with a male to female ratio of 1.36:1 and an average age of 6.2 years.2.Risk factors of bloodstream infection of multidrug-resistant bacteriaIn the multidrug-resistant group,38 cases of acute lymphoblastic leukemia(ALL),17 cases of acute myeloid leukemia(AML);34 cases of induction chemotherapy;neutrophil deficiency time before fever>7 days 30 cases;the lowest value of hemoglobin before fever was 75.00 g/L;the lowest value of platelet before fever was 20.73 xl09/L.Statistical analysis found that there were signifcant differences in acute leukemia type,chemotherapy stage,neutropenic time before fever,lowest hemoglobin before fever,and lowest platelet value before fever(P<0.05).There was no statistical analysis of age and gender.Learn the difference.(P>0.05).Acute myeloid leukemia,induction chemotherapy,neutrophil deficiency time before fever,lowest hemoglobin value below 70 g/L before fever,and minimum platelet value less than 20×109/L before fever are risk factor of bloodstream infection of multidrug-resistant bacteria in children with acute leukemia.3.Clinical features of bloodstream infection multidrug-resistant bacteriaIn the multidrug-resistant group,the mean procalcitonin(PCT)was 3.17ug/L,C-reactive protein(CRP)was 139.79mg/L,23 cases were respiratory infection,8 cases were skin and soft tissue infection,and 5 cases were digestive tract infection.There were 5 cases of oral mucosa and 14 cases of no obvious infection;the average fever time was 8.58 days;the initial empirical antibacterial treatment was effective in 18 cases,37 cases were ineffective;the antibacterial drug course was 14.98 days;12 cases were transferred to the intensive care unit,not transferred to 43 cases.6 patients died and 49 patients were cured.Statistical analysis found that PCT,CRP,initial empirical antibacterial treatment success rate,antibiotic treatment,intensive care unit transfer rate,mortality were significantly different(P<0.05),there was no significant difference in the distribution of infected sites(P>0.05).4.Pathogen distribution47 Gram-positive bacteria,17 Staphylococcus aureus,and coagulase-negative staphylococci.12 strains of strains and Streptococcus.There were 74 Gram-negative bacteria,21 strains of Escherichia coli,Pseudomonas aeruginosa and Klebsiella pneumoniae..There were 55 multi-drug resistant groups,31 Gram-positive bacteria,10 coagulase-negative staphylococci,and 8 strains of Staphylococcus aureus.There are 7 strains of Streptococcus.There are 24 Gram-negative bacteria,including 14 strains of Eschernchia coli and 4 strains of Klebsiella pneumoniae.5.Distribution of drug resistanceA total of 121 pathogenic bacteria were included,47 of which were G + bacterna.47 were Gram-positive.No staphylococcus aureus strains resistant to levofloxacin and linezolid,teicoplanin and vancomycin.The sensitivity rates ofcoagulase-negative staphylococcito linezolid and vancomycin were above 95.0%.No resistant strain to teicoplanin was found.No streptococcus strains resistant to levofloxacin and linezolid,teicoplanin and vancomycin.Among the 74 Gram-negative bacteria,the sensitivity rate of Escherichia coli to meropenem,amikacin and piperacillin tazobactam remained above 90%.The sensitivity rate of Klebsiella pneumoniae to piperacillin tazobactam and meropenem was over 90.0%.No drug-resistant strains of amikacin and levofloxacin were found.The sensitivity rates of Pseudomonas aeruginosa to levo:floxacin and cefoperazone sulbactam was over 90%.No strains resistant to amikacin or piperacillin was observed.Among the 55 multi-drug resistant strains,the resistance rates of multi-drug resistant Gram-positive bacteria to linezolid,teicoplanin and vancomycin were more than 95.0%,and no drug-resistant strains were found:in teicoplanin.The resistance rate of multi-drug sensitivity Gram-negative bacteria to amikacin and piracetam tazobactam twas over 85%.The sensitivity of meropenem in carbapenem antibiotics exceeds 90.0%.6.Clinical features of dead childrenThe average age of dead childeren was 6.14 years old.There were 4 males and 3 females,and the ratio of male to female was 1.33:1.There were 6 children with acute lymphoblastic leukemia and 1 patient with acute myeloid leukemia.There were 6 children in the induction chemotherapy stage and 1 child in the consolidation stage.The main site of infection is the respiratory tract.The lowest value of leukocytes before infection was 0.73×109/L,the lowest value of neutrophils was 0.34×109/L,the lowest value of hemoglobin before infection was 75.43g/L,and the lowest value of platelet was 22.29×109/L.The mean procalcitonin was 53.3ug/L for the first fever and the average C-reactive protein was 142.89mg/L.The neutrophil deficiency time before fever was 11.29 days,and the total neutrophil deficiency time was 21.43 days.The total fever time is 18.29 days.Six cases of multi-drug resistant bacteria infection.The initial empirical treatment was effective in 1 case.The average anti-infective course of treatment was 20.14 days.Procalcitonin(P=0.000),total duration of neutropenia(P=0.002),duration of neutrophil deficiency before fever(P=0.002),fever duration(P= 0.000),multi-drug resistant infection rate(P=0.046),anti-infective treatment(P=0.004),and initial empirical treatment efficiency(P=0.019)were significantly different from those of cured children.7.Research conclusions(1)The pathogens of bloodstream infection in children with acute leukemia are mainly Gram-negative bacteria.The most important Gram-negative strains are Escherichia coli,Klebsiella pneumoniae and Pseudomonas aeruginosa;the most important Gram The positive strain is Staphylococcus aureus.(2)In this study,Gram-negative bacteria strains remained highly sensitive to carbapenem antibiotics.(3)Gram-positive strains in this study still maintain a high sensitivity rate to the linezolid,vancomycin and teicoplanin.(4)Risk factors of bloodstream infection multidrug-resistant bacteria in children with acute leukemia:acute myeloid leukemia,induction chemotherapy,granulocytosis time before fever more than 7 days,hemoglobin before infection less than 70g/L and pre-infection platelets less than 20×109/L.(5)The pathogens of multidrug-resistant bacilli in children with acute leukemia are mainly multidrug-resistant Gram-positive bacteria,and the main multidrug-resistant Gram-positive strains are coagulase-negative staphylococci and methicillin-resistant Staphylococcus aureus and Streptococcus,the main multi-drug resistant Gram-negative strain is Escherichia coli.(6)The multidrug-resistant Gram-negative strains in this study remained highly sensitive to carbapenem antibiotics.(7)The multidrug-resistant Gram-positive strains in this study are still highly sensitive to linezolhd,vancomycin and teicoplanin.(8)The clinical features of children with acute leukemia complicated with bloodstream infection multidrug-resistant bacteria include:severe inflammatory response,long fever,low initial effective treatment rate,long antibiotic course,higher intensive care unit transfer rate and death rate.(9)The clinical features of death with acute leukemia complicated with bacterial bloodstream infection are long-term granulocytosis,long total granule deficiencies,elevated procalcitonin during primary fever,infection of multidrug-resistant bacteria,longer fever time,low initial sensitivity to treatment and long duration of antibiotic use. |
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