| FN infection and risk factors analysisObjective Febrile neutropenia is a common complication of acute leukemia chemotherapy,associated with serious bacterial infection sepsis,increase the cost of hospitalization and mortality.The aim of this study was to study the risk factors of invasive bacterial infection in children with FN,in order to guide the clinical evaluation of early disease.Method From January 2012 to December 2015 there were newly diagnosed 131 cases of acute leukemia(except M3)at the Department of Hematology of The children’s Hospital Affiliated to Shanghai Jiaotong University School of Medicine,to June 2016 in our hospital were followed up for at least 6 months(the longest follow-up period of <3 years).During this period 420 cases of FN were collected,and record the general data,clinical symptoms,laboratory examination indexes,the primary endpoint of the fatality rate,the data were analyzed by single factor analysis,on the basis of the choice of a statistical difference between the variables,the data were analyzed by multiple factor regression analysis Logistic.Results Collected a total of 420 cases,severe sepsis occurred in 91 cases,the incidence was 21.7%(91/420).1.91 cases in severe sepsis group,9 cases died(9.8%),the death of 3 cases occured after gave up;329 cases in severe sepsis group,no death occured.Severe sepsis mortality rate was significantly higher than that of the non severe sepsis group,there were significant differences between the two groups(X2=75.9,P<0.001).2.Analysis of single factor :ANC<0.5*10^9/L、ANC<0.5*10^9/L lasting more than 7 days、the bloodstream infection、extended length of hospital stay are the risk factors of severe sepsis in FN infection.3.Logistic multivariate regression analysis results: Bloodstream infections is the most strongly factor that lead to severe sepsis,the odds ratio is OR=6.589,95%CI:1.246-33.214,followed by ANC<0.5*10^9/L,odds ratio OR=0.954,95%CI:0.921-0.994,followed by the average neutropenia time is greater than the 7 day,OR=2.310,95%CI:1.164-4.594,these factors are independent risk factors for FN severe sepsis.Conclusion ANC<0.5*10^9/L、ANC<0.5*10^9/L duration of >7 days、the bloodstream infection were FN severe infection independent risk factors,can be early clinical assessment indicators.Bacterial infection analysisObjective To understand the changes of the pathogenic bacteria in the blood culture of Febrile Neutropenia(FN)in children with acute leukemia.Method From January 2007 to December 2015,253 patients with acute leukemia were newly diagnosed in Department of Hematology,Shanghai Children’s Hospital,and to June 2016 all patients were followed up for at least 6 months(the longest follow-up period was <3 years).During the period of FN after chemotherapy combined with blood culture positive in 127 cases,according to the blood culture of Gram stain divided into gram positive bacteria(68 cases)and gram negative bacteria(59 cases);January 1,2012 as the time division is divided into before 5 years group(74 cases)and after 5 years group(53 cases),record statistical results and analysis of microbial drug resistance of common pathogenic bacteria in FN,change tendency and drug resistance,to summarize the FN features of pathogens of bacterial infection.Results1.The overall incidence of bacteremia in FN was 12.5%,gram positive bacteria 53.5%(68 strains),gram positive bacteria 46.5%(59 strains),The common pathogens were Staphylococcus epidermidis,Escherichia coli,Pseudomonas aeruginosa.Coagulase negative staphylococcus is the most common gram positive bacteria,Escherichia coli was the most common gram negative bacteria.2.In the before 5 years group and after 5 years group,the gram positive bacteria were the main pathogenic bacteria(51.3%:48.7%VS56.7%:43.3%),there was no significant upward trend in the infection of gram positive bacteria(X2=7.8,P>0.05),there was no significant difference between the two groups.3.In the group of gram positive bacteria,88.9% strains of coagulase negative staphylococcus,methicillin resistant,Staphylococcus aureus in 85.7%,no vancomycin resistant strains;gram negative bacteria group,Escherichia coli and Klebsiella pneumoniae.The detection rate of ESBLs were 42.8% and 33.3%,the resistance of ESBLs producing strains most of the antibiotics are higher than that of non ESBLs producing strains,the highest susceptibility to carbapenems.Conclusion Gram positive bacteria were the main pathogens of bacterial infection;Coagulase negative staphylococcus is the most common gram positive bacteria,Escherichia coli was the most common gram negative bacteria;combined with drug resistance analysis,to provide a reference for early drug selection.Application value of chest CT in early diagnosis of pulmonary fungal infectionObjective To analyze the common signs of chest CT in children with pulmonary fungal infection(PFI),and to explore the application value of the method in the early diagnosis of pulmonary fungal infection.Method Retrospective analysis of 131 cases of newly diagnosed acute leukemia in Department of Hematology,Shanghai Children’s Hospital from January 2012 to December 2015.All cases was followed up for at least 6 months(the longest follow-up period was <3 years).During this period after chemotherapy with PFI118 combined with FN,according to the diagnostic criteria in line with the European cancer research and treatment organization(EORTC)standard,which confirmed 2 cases,53 cases of clinical diagnosis,63 cases were diagnosed suspectively.Statistical analysis included laboratory examination,chest CT findings,and discuss the application value of chest CT in the early diagnosis of PFI.Results1.Clinical manifestations: first fever accounted for 94.3%(111/118),,cough accounted for 42.6%(50/118),shortness of breath accounted for 21.3%(25/118),oxygen saturation decreased accounted for 14.6%(17/118).Among them,4 cases were complicated by fungal infection of digestive tract,mainly white foam like watery stool,,1 cases with deep tissue(liver)infection and 1 cases of skin infection.2.Laboratory examination:The positive rate of 1,3-β-D glucan experiment(G experiment)at the frist time of admission was 52.5% (62/118)and galactomannan(GM experiment)were 40 cases,positive rate was12.5%(5/40),the G positive rate was higher than GM(52.5%VS12.5%,P<0.05),the two groups there was significant difference on the 118 cases of fungal culture out of 4 strains of Candida,the positive rate was 4.5%,4 strains were Candida albicans.3.Chest CT: Chest CT manifestations of various forms,mainly manifested as diffuse or mass like inflammatory exudation,interstitial changes,nodule or mass shadow,or contain holes,some severe cases with pleural effusion.The inflammatory exudate in the lung were 57 cases,showed diffuse exudation,homogeneous or inhomogeneous density;interstitial change in 20 cases;two pulmonary solitary or multiple nodules in 34 cases of 3-10 mm,about 28.8% of the total number of cases,including 3 cases of empty hole;cases of pleural effusion in 8 cases.Chest CT changes appear in clinical symptoms appear after the first 1-5 days,after positive anti-infection and symptomatic treatment,the first 7-15 days of the chest CT showed signs of improvement.Conclusion Chest CT forms diversed,nodules for children is relative specific fungal infection HRCT change;G test has high sensitivity,false positive rate is high;the positive rate of GM test is low,the chest CT is a reliable way for early diagnosis of pulmonary fungal infection. |
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