Clinical Analysis Of Chemotherapy-related Bloodstream Infection In Children With Hematological Malignancies

Objective: To summarize the occurrence of bloodstream infection in children with hematologic malignancies in our hospital after chemotherapy,and to analyze the clinical characteristics,susceptible infection sites,the distribution characteristics of pathogenic bacteria,resistance situation of pathogenic bacteria and factors affecting the treatment efficacy of bloodstream infection in children with malignant blood disease,so as to further help and guide the clinical diagnosis and treatment.Methods:A retrospective anlysis was made on the clinical data,pathogenic bacteria and drug sensitivity results of 101 cases with malignant hematological diseases complicated with bloodstream infection from September 30,2014 to October 31,2020 in the pediatric hematology ward of the second hospital of Hebei Medical University.The collected clinical data were classified according to statistical methods,and the data were entered into SPSS 24.0 software for statistical analysis.Results: 1.Among the 101 cases of malignant hematopathy complicated with bloodstream infection,65 cases were male(64.36%)and 36 cases were female(35.64%),male: female =1.81/1,and the mean age was 7.78±4.12 years.2.Infection rate and mortality rate: in this study,the infection rate of children with hematological malignancies complicated with bloodstream infection was 1.41%.Among the children with bloodstream infection,79 cases turned negative in blood culture after effective treatment and their symptoms improved and were cured,with a cure rate of 78.22%,and 22 cases gradually deteriorated and died,with a mortality rate of 21.78%.3.The distribution of bloodstream infection in primary disease:The distribution of bloodstream infections in the primary disease in descending order of incidence was acute mixed cell leukemia(20.51%),acute myeloid leukemia(5.88%),malignant lymphoma(1.90%),and acute lymphoblastic leukemia(0.57%).4.Infection foci associated with bloodstream infection:When bloodstream infection occurred,most of the children did not have a clear associated site of infection,57.43% of the children did not have a clear associated focus of infection,42.57% of the children had a clear associated focus of infection,of which the most common site was the lung(33.66%),and the other sites were skin(2.97%),peripherally inserted central catheter(2.97%),perianal(1.98%),and intestinal(0.99%).5.Species and drug resistance of pathogenic bacteria:Among the 101 strains of pathogenic bacteria detected,79 strains(68.32%)were gram-negative bacteria,29 strains(28.71%)were gram-positive bacteria,and 3 strains(2.97%)were fungi,among which the top five strains were Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa,Staphylococcus epidermidis,and Staphylococcus hominis.The drug susceptibility test results showed that the drug resistance rate of Gram-negative bacteria to ampicillin,piperacillin,ampicillin/sulbactam and second or third generation cephalosporin was higher than 70%,and the drug resistance rate to carbapenase antibiotics and amikacin was lower.The drug resistance rate of Gram-positive bacteria to phenoxacillin,cefoxitin,cotrimoxazole,clindamycin,erythromycin was more than 50%,and the drug resistance rate to moxifloxacin,linezolid,quinupridine,tegacycline,vancomycin was lower.The detection rate of multi-drug resistant bacteria in Gram-negative bacteria was 6 strains(5.94%),and that in Gram-positive bacteria was 12 strains(11.88%).The three fungi detected were sensitive to antifungal drugs.6.Factors influencing therapeutic effect:Among the factors affecting the treatment effect,platelet count and the correct choice of antibiotics were related to the treatment effect.The higher platelet count group and the correct choice of antibiotics group had better treatment effect,and the difference was statistically significant.There was no significant correlation between hospitalization days,age,hemoglobin count,neutrophils count and treatment effect,and the difference of treatment effect was not statistically significant.Conclusion:1.The mortality rate of children with hematologic malignancy was high,and children with acute mixed cell leukemia as the primary disease had the highest incidence of bloodstream infection.Most children with bloodstream infection did not have clear associated infection foci,but pulmonary infection was the most common among those with clear associated infection foci.2.The main pathogens of bloodstream infection in children with hematological malignancies were Gram-negative bacteria,followed by Gram-positive bacteria,and the detection rate of fungi was significantly lower.Gram negative bacteria were mainly sensitive to carbapenems and amikacin.Gram positive bacteria were sensitive to linezolid,quinuptin,tigecycline and vancomycin.3.Timely correct and effective anti-infective therapy and platelet infusion had an important influence on the prognosis of children with hematologic malignancy when blood stream infection occured.