Clinical Analysis Of Infection After Intermediate-high Dose Cytarabine Consolidation Theraphy In Patients With Acute Myeloid Leukemia

Objective:To explore the clinical characteristics,influencing factors and preventive measures of nosocomial infection in patients with acute myeloid leukemia(AML)after chemotherapy with intermediate-high dose of cytarabine(Ara-C).Methods:The clinical data of 80 AML patients treated with intermediate-high dose Ara-C regimen in the Second Hospital of Shanxi Medical University from 2013 to 2020 were collected and analyzed retrospectively:(1)Nosocomial infection rate,infection site and pathogen distribution;(2)The effects of age,AML classification,prognosis grade,infection during induction chemotherapy,other diseases,dosage of Ara-C,course of treatment of Ara-C,antibiotic prevention and blood routine before chemotherapy on infection of patients;(3)The effect of using aseptic laminar flow ward;(4)Influence of infection on hospitalization time,neutrophil recovery time,platelet recovery time and hospitalization expenses.Results:1.Among 80 AML patients who received intermediate-high dose Ara-C chemotherapy,there were 41 males and 39 females with a median age of 34(12-68)years.FAB classification:M1 2 cases,M2 20 cases,M4 15 cases,M5 6 cases,and unclear classification in 37 cases.Prognostic grade:good prognosis in 22 cases,moderate prognosis in 39 cases and poor prognosis in 19 cases.72 patients were infected during induction chemotherapy.There were 23 patients with other systemic diseases.The total course of cytarabine chemotherapy for each patient was 17 cases in 1 course,26 cases in 2courses,15 cases in 3 courses and 22 cases in 4 courses.80 patients completed 198 courses of chemotherapy.The median hospitalization time was 21 days,the median neutrophil recovery time was 10 days,and the median platelet recovery time was 12 days.The average hospitalization cost was 3.66±1.24 yuan.2.In 198 chemotherapy cycles,there were 144 infections,and the infection rate was72.73%(144/198).The frequency of infection sites from high to low is respiratory tract(30.00%),lung(27.27%),gastrointestinal tract(18.18%),perianal region(7.27%),oral cavity(6.36%),skin(5.45%),urinary system(3.64),perineum infection and liver and spleen fungal infection accounted for 0.91%respectively.3.A total of 45 strains of pathogenic bacteria were detected.Gram-negative bacilli accounted for 55.56%(25/45),mainly including Escherichia coli and Klebsiella pneumoniae.Gram-positive cocci accounted for 24.44%(11/45),mainly including Staphylococcus epidermidis and Enterococcus faecalis.Fungi accounted for 8.89%(4/45).Viruses accounted for 11.11%(5/45).4.The univariate analysis of the influencing factors of nosocomial infection in AML patients undergoing intermediate-high dose Ara-C chemotherapy showed that the nosocomial infection rate increased after intermediate-high dose Ara-C chemotherapy in patients with infection during induction chemotherapy(P<0.001,χ~2=12.456),which was the risk factor of nosocomial infection.Antibiotic prevention can significantly reduce the infection rate(P=0.017,χ~2=5.651).5.Multivariate logistic regression analysis showed that infection during induction chemotherapy(P=0.001,OR=5.076)was an independent risk factor for nosocomial infection after intermediate-high dose Ara-C chemotherapy,while antibiotic prevention(P=0.014,OR=0.332)was an independent protective factor.6.There was no significant difference in infection rate between sterile laminar flow ward and general ward.There was no significant difference in cytarabine dose,hospitalization time,neutrophil recovery time and hospitalization cost between the two groups.7.The hospitalization time(P<0.001),neutrophil recovery time(P<0.001),platelet recovery time(P=0.002)and hospitalization expenses(P<0.001)of the infected group were higher than those of the non-infected group,and the difference was statistically significant.Conclusion:1.The infection rate of intermediate-high dose Ara-C chemotherapy is high,with upper respiratory tract,lung and gastrointestinal tract infection as the main infection,and Gram-negative bacilli infection as the first.2.Infection during induction chemotherapy(P=0.001,OR=5.076)was an independent risk factor for nosocomial infection after intermediate-high dose Ara-C chemotherapy,while antibiotic prevention(P=0.014,OR=0.332)was an independent protective factor.3.For patients undergoing chemotherapy with intermediate-high dose Ara-C regimen,strengthening the environmental cleanliness of general wards may achieve the same effect as aseptic laminar flow wards.4.Infection increases the risk of treatment and the physical,psychological and economic burden of patients.Taking effective measures and actively preventing infection during chemotherapy is of great significance to reduce the burden on patients and improve the long-term survival rate.