Analysis Of Risk Factors For Breakthrough Fungal Infection In Children With Acute Leukemia

Objective:To analyse the risk factors of Breakthrough Invasive Fungal Infection（BIFI）in children with acute leukemia after chemotherapy,and to analyze the correlation between BIFI and the prognosis of children.Methods:Collect the case data（age,gender,risk,etc.）of children with acute leukemia admitted to the Children’s Hematology and Oncology Department of the Second Affiliated Hospital of Anhui Medical University from January 2015 to August 2020 and the infection status during hospitalization（types of broad-spectrum antibiotics,Agranulocytosis days,red blood cell transfusion,mucositis,etc.）,of which 28 children with BIFI were used as the research group,of which 18 were children with Acute Lymphoblastic Leukemia（ALL）,and 10 were with Acute Myeloid Leukemia（AML）,92 children with acute leukemia in the same period,same sex,same course of treatment,same age group,and same risk level without BIFI were selected as the control group,including 72 cases of ALL and 20 cases of AML.The clinical data of childhood acute leukemia combined with BIFI were retrospectively analyzed,and the possible risk factors of childhood acute leukemia combined with BIFI were analyzed by multivariate Logistic regression.Results:Among the 90 cases of ALL children collected,48 were males and 42 were females,with a male-to-female ratio of 1.14:1,15 low-risk（LR）cases,70 intermediate-risk（IR）cases,and 5 high-risk（HR）cases,among the 30 children with AML collected,16 were males,14were females,the ratio of male to female was 1.14:1,LR0 cases,IR27 cases,and HR3 cases.Univariate analysis found that in ALL children,red blood cells Infusion≥3.5U/m~2,mucositis,glycopeptide antibiotics,neutrophil deficiency days≥7 days,use of≥4 kinds of antibiotics,CRP≥30.0mg/L,low CD4+percentage and application time of broad-spectrum antibiotics≥7 days are related to the occurrence of BIFI（P<0.05）;In children with AML,mucositis,red blood cell transfusion≥5U/m2,CRP≥30.0mg/L,low CD4+percentage and neutrophil deficiency≥7 days are associated with the occurrence of BIFI（P<0.05）;multivariate logistic regression analysis found that in ALL children,Red blood cell infusion≥3.5 U/m~2,mucositis,and broad-spectrum antibiotics≥7 days were independent risk factors for BIFI（P<0.05）;in children with AML,no independent risk factors for BIFI were found.Conclusion:In addition to prolonged neutropenia,central venous catheter（CVC）,hypoalbuminemia,etc.,in addition to red blood cell transfusion≥3.5U/m~2,mucositis,CRP≥30.0 mg/L and the use of broad-spectrum antibiotics for≥7 days are also independent risk factors for BIFI in children with acute leukemia.Therefore,strictly grasping the indications for blood transfusion and avoiding the unreasonable application of antibiotics and the occurrence of mucositis can help reduce the occurrence of BIFI.At the same time,the occurrence of BIFI is associated with the occurrence of sepsis and higher mortality.