Clinical Analysis On Nosocomial Infection In Adults With Acute Leukemia After Chemotherapy

ObjectivesTo investigate the characteristics of nosocomial infection,distribution of the pathogenic bacteria and resistance, analyze thepredisposing factors in patients with acute leukemia in adult afterchemotherapy and provide evidence for its prevention and treatment.Materials and methodsA retrospective review of the medical records of89patients in ourhospital with acute leukemia admitted between July,2010and Dec,2011was performed. They finished341times of chemotherapies. The incidence,pathogenic microorganism and susceptible factors of infectiouscomplications were analyzed. The data were analyzed with the single riskfactors through chi-square test and multifactor binarylogistic-regression analysis.Results341cases of time in chemotherapy, with179cases of infection, theincidence of nosocomial infection was52.2%, the total infection siteswere241cases of time, incidence rate was70.7%, which consisted of asingle site infection for123cases of time; two sites infection for41cases of time; three sites infection for6cases of time; four partsinfection in3cases of time; infection of unknown sites for6cases oftime. In all the infections，the most common nosocomial infection siteswere upper respiratory tract infection accounting for22.8%; pulmonaryinfection accounting for24.1%;oral infection and sepsis were bothoccupying12.4%;the perianal infection and intestinal infectionoccupied7.1%and4.1%respectively; Skin soft tissue infection and Urinetract infection occupying3.3%and2.1%respectively; acute appendicitisand herpes virus infection occupying2.1%and1.2%respectively; pelvicinflammation and lymphadenitis occupying1.2%and0.8%respectively.infectivity endocarditis, ocular infections, Infection of externalauditory canal, peritionitis were all occupied0.4%, case-time incidencewere all in0.3%; infection of unknown were accounted for2.5%.241cases of time in the232cases times of infections sent samplesto laboratory examination for cultivate bacteria,59times got positiveresult, positive rate was25.1%.17pathogens were acquired, including10gram-negative bacterium (36strains), occupied61.0%, and the top threebacteria were klebsiella pneumoniae, escherichia coli and pseudomonasaeruginosa.9Gram-Positive Bacteria (20strains)were obtained,accounting for33.9%, staphylococcus haemolyticus and Enterococcusfaecium were the most common two bacteria.1fungus (3strains) beenfound, accounted for5.1%, all of them were candida albicans (3strains).Fungus infection were diagnosis34cases of time, incidence rate14.1%, the site of these infection were lung25cases of time accountingfor73.5%, oral cavity7cases of time accounting for20.6%, intestinaltract2cases of time accounting for5.9%.Blood culture positive rate was13.6%(30/220), sepsis rate was16.8%(30/179).30cases times sepsis cultivated11strains of bacteria,including5strains of gram-negative bacterium,5strains of gram-postivebacterium; The single factor analyzed results show that Disease status,elevated WBC counts before treatment, length of hospitalization,glucocorticoid therapy, high quality wards or streamline flowwards,neutrophil counts, days of agranulocytosis, hemoglobin,the levelof blood platele,Albumin were found as risk factors of nosocomialinfection(P<0.05),but not correlated with sex,age,FAB types,diabetesmellitus, peri-anus diseases, central line,Thymopeptides, G-CSF(Granulocyte colony stimulating factor) or globulin (P>0.05).The binary regression showed that length of hospitalization（OR=1.751）, and disease status（OR=0.370）days of agranulocytosis（OR=14.676）, glucocorticoid therapy（OR=2.069）and high quality wardsor streamline flow wards（OR=3.225）were indepent risk factors fornosocomial infection with acute leukemia.ConclusionThe nosocomial infection rate of acute leukemia in adult afterchemotherapy was high, about one thirds of patients got two or more thantwo sites infection after chemotherapy, we need to pay more attention tothese situation.Common infective sites were upper respiratory tract, lung, oralcavity, blood, peri-anus and intestines, the most commonly identifiedorganisms was gram-negative bacteria, during the treatment we should paymore attention to the infective site, check the patients more frequentlyonce a suscipious patient was diagnostic, before the culture result comesout the gram-negative bacteria primarily of antibiotics should be thefirst selection of empirical anti-infection treatment.Multidrug resistant was common seen in nosocomial infection；weshould used the antibiotic more reasonable. Days of agranulocytosis, high quality wards or streamline flowwards, length of hospitalization, glucocorticoid therapy and diseasestatus, were independent risk factors for nosocomial infection withacute leukemia in adult. We can control nosocomial infectioneffectiviely through identifying these high risk factors and takingtargeted measures of prevention.