Clinical Analysis On Nosocomial Infection In Acute Leukemia After Chemotherapy

Objective：To investigate the characteristics of nosocomial infection in patients withacute leukemia after chemotherapy and provide basis for its prevention and treatment.Materials and methods：A retrospective review of the medical reeords of95patientswith acute leukemia admitted between June,2006and June,2011was perofrmed.Theyfinished184chemotherapies.The incidence,pathogenic microorganism andsusceptible factors of infectious complications were analyzed.The data were analyzedwith the single factor χ~2test and multifactor logistic-regression analysis.Results：1.184cases of time in chemotherapy,with123cases of infection,theincidence of nosocomial infection was66.8%,the total infection sites were160casesof time, which consisted of a single site infection for92cases of time;two sitesinfection for17cases times;three sites infection for7cases times;four parts infectionin2cases times;infection of unknown for5cases times;the case-time incidence was80.0％.2.All the infections,upper respiratory tract infection was61cases times inall,accounting for38.1%of all the infections,case-time incidence was33.2%;pulmonary infection was27cases times in all,accounting for16.9%,the case-timeincidence was14.7%;oral infection and sepsis were20and18cases timesrespectively,occuping12.5%and11.3%, and their case-time incidences were10.9%and9.8%separately;the intestinal infection and perianal infection, respectively11and6cases times,occupying6.9%and3.8%, case-time incidence were6.0%and3.3%respectively; acute appendicitis and infection of unknown were both5cases,accounting for3.1%respectively,case-time incidence were both2.7%;suppurative tonsil and soft tissue infection were both2cases times respectively,accounting for1.25%seprearately,their case-time incidences were both1.1%;herpes zoster virus infection and urinary tract infections both1case time,accounting for0.6%,their case-time incidences were both0.5%.3.102cases of time to laboratory examination.for example,cultivate bacteria,27times got a positive result,positive rate was26.5%.pathogens were mainlygram-negative bacterium (16strains),occupied59.3%,respectively escherichia coli(5strains)、klebsiella pneumoniae(3strains)、pseudomonas aeruginosa(2strains)、stenotrophomonas maltophilia (1strain)、enterobacter cloacae (1strain)、bacillussubtilis (1strain)、alcaligenes(1strain)、enterobacter aerogenes(1strain)、proteusmirabilis(1strain);gram-positive (9strains) accounted for33.3%, with Enterococcusfaecium(2strains)、staphylococcus epidermidis(2strains)、staphylococcus hominis(1strain)、dural golden coli septic(1strain)、staphylococcus aureus(1strain)、staphylococcus cohnii(1strain)、 streptococcus mutans(1strain);fungus (2strains)accounted for7.4%,respectively east-like fungi (1strain)and yeast candidaalbicans(1strain); the resistance rate to commonly used antibiotics was high, thedetection rate of ESBLs in escherichia coli、klebsiella pneumoniae、 pseudomonasaeruginosa were40%、25%、100%.4.The blood culture positive rate was19.6%(19/92), sepsis rate was10.3%(19/184).19cases times sepsis cultivated11strains of bacteria, including7strainsgram-negative bacterium,4strains gram-postive bacterium;5.The single factor analyzed results show that age（χ~2=13.06）,stage of treatment（χ~2=28.8）,seasons of hospitalization（χ~2=9.9）, neutrophil in peripheral blood（χ2=19.8）,hemoglobin（χ~2=18.9）,the level of blood platele（tχ~2=45.8）,glucocorticoidchemotherapy,corticosteroids therapy （χ~2=6.3）,length of hospitalization （χ2=32.8）,intensity of chemotherapy（χ~2=6.0）were found as risk factors of nosocomialinfection(P<0.05),but not correlated with sex,FAB types（χ~2=0.17） or traumaticoperation（χ~2=1.56）(P>0.05);6.The binary regression showed that length of hospitalization （OR=6.856）,glucocorticoid chemotherapy（OR=3.925）, intensity of chemotherapy（OR=3.591）,seasons of hospitalization（OR=3.296）and ag（eOR=2.580）were indepent risk factorsfor nosocomial infection with acute leukemia. Conclusion：1.The nosocomial infection rate of acute leukemia after chemotherapywas high.,common infective sites were respiratory、 oral and blood, the mostcommonly identified organisms was gram-negative bacteria, gram-negative bacteriaprimarily of antibiotics should be the first selection of empirical anti-infectiontreatment.2.Bacteria is present a trend that is single resistance to multiple resistance, lowresistance to high resistance,we should be careful to choose reasonable antibacterialdrugs.3.Length of hospitalization, glucocorticoid chemotherapy, intensity ofchemotherapy, seasons of hospitalization and age were indepent risk factors fornosocomial infection with acute leukemia.We can control nosocomial infectioneffectiviely through identifying these high risk factors and taking targeted measures ofprevention.