Related Factors Analysis Of Nosocomial Infections In Acute Leukemia

ObjectiveTo investigate the characteristics of nosocomial infection in patients with acute leukemia and establish unconditional Logistic Regression Model using retrospective case study, search for independent risk factors and then take corresponding preventive measures to verify the credibility of this model through prospective case study.MethodsTwo groups of patients were analyzed in the current study:311 patients who were hospitalized and diagnosed AL at the Department of Hematology, Shandong Provincial Hospital from July 2006 to July 2008. Of the 311 AL patients,144 with nosocomial infections (NI group) and 167 without nosocomial infections (non-NI group) were analyzed using retrospective study. Univariate chi-square test and unconditional Logistic Regression Model multivariate analysis were carried out to screen NI independent risk factors. 193 patients diagnosed AL from August 2008 to December 2009 were then taken corresponding preventive measures and studied using prospective study. NI incidence rate and mortality rate were calculated and compared with that in patients without corresponding preventive measures.ResultsNI incidence rate and mortality rate were decreased obviously accepted preventive measures (36.3%,10%) when compared with patients without corresponding preventive measures (46.3%,20.8%). The incidence of nosocomial infection was 46.3%(144/311), mainly consisting of respiratory tract, blood and oral infection. No recognized sites could be found in certain patients with nosocomial infection. The most common pathogens were gram-negative bacilli(46.6%), which were relatively sensitive to Imipenem/Cilastatin Sodium(TIENAM), Amikacin, Ceftazidine. The gram-positive cocci were relatively sensitive to Vancomycin and Ceftazidine. The analyzed results show that age, corticosteroids therapy, absolute neutrophil count in peripheral blood, cycles of chemotherapy, length of hospitalization, stages of treatment, the latest infections and seasons of hospitalization were found as independent risk factors of nosocomial infection.Conclusions1. The incidence of nosocomial infection in patients with acute leukemia is high. In order to reduce the death rate, improve level of therapy and prolong survival periods of these patients, positive measures should be taken to prevent and treat nosocomial infection.2. The conditional pathogenic bacteria are the main pathogens in nosocomial infections in patients with acute leukemia, and most of them are resisted to antibiotics. As infections in these patients are usually severe and complicated, with poor prognosis, so antibiotics selection upon experiences should be taken rapidly. General principles of antimicrobial therapy should also be applied, including administration in time, high-effective, broad-spectral and bactericidal drug combination. Adequate dosage and duration of antimicrobial therapy are also important.3. Age, corticosteroids therapy, absolute neutrophil count in peripheral blood, cycles of chemotherapy, length of hospitalization, stages of treatment, the latest infections and seasons of hospitalization are independent risk factors for nosocomial infection in patients with acute leukemia.4. Corresponding measures against neutrophil number in peripheral blood, admission day, recent infection and season have some feasibility.