Risk Factors Of Nosocomial Infection In Adults With Acute Leukemia

Nosocomial infection(NI) is defined as the infection acquired by all modes of transmission that occurred in hospital or acquired in hospital but attacked after leaving hospital. However, it doesn't contain the infection that acquired before admission. NI is always a difficult problem in hospital administration. In the introduction of "hospital-acquired infection prevention and control guidelines", WHO clearlly stressed that nosocomial infection will be become an increasingly serious public issue.In the hematology department, the incidence of NI is high. The unique characteristics of NI in patients with hematologic malignancies are as follows, complicated clinical manifestations, dangerous condition, high incidence of serious infection and the mortality, which has been a risk to patients' lives.Leukemia is a worldwide common hematological malignancies and one of the top ten malignancies with high incidence in China. While acute leukemia is a kind of hematopoietic stem cell clone disease with massive proliferation of primitive and naive bone marrow cells, it has abnormal quality and quantity of leukocytes and with varying degrees of immunocompromised state. So acute leukemia patients are the high-risk groups of nosocomial infection. Prevention and control of nosocomial infection has been important aspects in improving the treatment efficacy and extending the survival time of patients with acute leukemia. So, we choose acute leukemia for study.Hospital infection control is no longer a simple disinfection, air bacterial culture or infection monitoring reports. In the aspect of hospital infection prevention and control, WHO pointed out a series of instructive recommendations, such as "to conduct epidemiological surveillance", one of the most important steps to develop the plan of controlling NI. At present, some well-conditioned hospitals in China have developed targeted surveillance about some risk factors of NI, domestic good foundation hospitals are gradually unfold hospital infection risk factors related to objectives of monitoring. But there are few research target against acute leukemia hospital infection risk factors selection and multi-factor analysis, at the same time the current study does not represent national situation. Therefore, in order to provide an objective basis for the treatment of NI with acute leukemia, as well as providing data and the basis for initial monitoring study, we are committed to screening and identifying the risk factors of NI with acute leukemia in this study.ObjectiveTo study the risk factors of NI in adults with acute leukemia, provide basis for prevention and lay the foundation for targeted surveillance.MethodsA retrospective review of the medical records of 653 adult patients with acute leukemia admitted between July 2005 and July 2007 were performed, 386 cases were recorded as NI group and the other 267 without any infection were recorded as non-NI group. The data were analyzed with the single factor x~2 test and multifactor logistic regression analysis.Results1. The incidence of NI in adults with acute leukemia was 59.1%(386/653). During hospitalization patients often had repeated infection and the case-time incidence was 82.5%.2. The frequent NI sites in adults with acute leukemia were respiratory tract (51.7%), oral cavity (13.5%) and blood (11.7%).3. The most commonly identified organisms was gram-negative bacteria (50.4%). While the gram-positive was accounted for 33.3%, and the other identified organism was fungi. Virus infection also should not be ignored. For example, skin herpes virus infection and cytomegalovirus viremia were also common .4. The characteristics of pathogen infection: complicated pathogen infection, coexistence of bacteria fungus and virus, a wide range of pathogens. This study cultivated as many as 36 kinds of pathogens and most of bacteria were condition pathogens.5. Mono-factor analysis showed that the significant risk factors between the two groups included the season of hospitalization, type of leukemia, stages of treatment, WBC, platelet count, hemoglobin, prophylactic antibiotics, perianal diseases and corticosteroids therapy. Throughout the year, the lowest incidence rates was in winter (70.5%). In the three types of acute leukemia, acute myeloid leukemia has the highest incidence of NI (62.7%), followed by acute mixed type (60.5%),and the acute lymphoblastic leukemia (48.01%). In the initial induction stage, the incidence of patients with early chemotherapy is highest (74.4%). At the later stage, acute leukemia condition was under control, the tolerance to chemotherapy was increased and the susceptibility was decline. However, with the increasing of cycles of chemotherapy, NI increased again. This study also found that WBC count≤1.0×10~9/L, the incidence of NI rate was 72.7%; when the WBC≥10×10~9/L, the incidence of NI was as high as 83.3%.The incidence of NI decreased with the increasing concentration of hemoglobin, when Hb≤30g/L all the patients were infected in hospital, when Hb during was (30～60)g/L, the infection rate was 72.7%. the patients with moderate and mild anemia was 67.1% and 45.0% respectively Patients with platelet count≤30×10~9/L, the incidence of NI was 68.2%, when platelet count≤70×10~9/L or between (70～100)×10~9/L the incidence rate were very high, 61.1%, 62.5%. But within normal platelet count, the infection rate reduced to 27.7%. Preventive use of antibiotics was a risk factor, with NI incidence rate (78.4%), which was higher than those with non-preventive use of antibiotics (51.2%). The morbidity of patients with perianal disease was higher (68.5%) in NI than those without perianal disease(56.9%). The incidence of NI for patients without sugar glucocorticoid chemotherapy (57.4%) was lower than that with glucocorticoid therapy.6. There were 5 statistically significant variables in multivariate analysis. Preventive use of antibiotics, glucocorticoid, perianal disease were independent risk factors of NI for patients with Acute Leukemia, while the concentration of hemoglobin, platelet count were protective factors.Conclusions1. The NI rate in adults with acute leukemia was high. The patients often had occurred repeated and multiple sites of infection. Pathogen infection was complex, most of which were conditioned pathogen.2. The main infection site of hospital infection in adults with acute leukemia was respiratory tract, oral cavity, blood, etc. In the process of treatment and care, we needed to pay special attention to early detection and early treatment.3. The binary logistic regression showed that prophylactic antibiotics, corticosteroids therapy and perianal diseases are independent risk factors for NI in adults with acute leukemia. Increase the amount of hemoglobin and platelet count will help to control the hospital infection. We can control of NI effectively through identifying these high risk factors and taking targeted measures of prevention.