Infections In Children With Acute Lymphoblastic Leukemia Following Induction Chemotherapy

Objective To analyze the rate, type, risk factor, etiology, therapy and the treatment cost of hospital-acquired infections, provide scientific basis for prevention and control of hospital-acquired infections, and clinical logically used antimicrobial drug, to ensure the chemotherapy completed successfully.Methods We retrospectively analyzed infectious complications of70patients who received induction chemotherapy between May13th2012and May14th2013.Results(1) Among70children with acute lymphoblastic leukemia,46children suffered from hospital-acquired infection, the prevalence was63.7%, and there were82cases hospital-acquired infections and the case prevalence was117.1%.(2) Infection site:there were17cases of upper respiratory tract infection,24cases of lower respiratory tract infections,18cases of sepsis,7cases of skin infections;8cases of oral mucosa;5cases of digestive tract infection;2cases of infection occurred in unknown site; and1cases of herpes zoster.(3) Infection time:62.1%infection cases occurred in the third week during induction chemotherapy,20.8%occurred in the fourth week. (4) A total of24strains of pathogens causing hospital-acquired infections were isolated from124times of culture, the positive rate was19.35%. Pathogens were mainly gram-negative bacterium (19strains), occupied79.17%, including pseudomonas aeruginosa (7/24) and klebsiella pneumoniae (4/24), escherichia coli (3/24), acinetobacter baumannii (2/24), Acinetobacter junii (1/24), water vapor single cell bacteria (2/24). Gram-positive bacterium (5strains),occupied16.67%,were enterococcus strains (2/24), hemolytic staphylococci (1/24) and micrococcus luteus (1/24) respectively. Fungi accounted for4.17%, just1strain of Candida albicans.(5)Most of gram-negative bacteria were sensitive to antimicrobials such as carbapenems, cefoperazone sodium and sulbactam sodium, Piperacillin Sodium and Tazobactam Sodium, Amikacin, resistance rate to the first and the second generation cephalosporins. Gram-positive bacteria were sensitive to vancomycin and teicoplanin, had a high resistance rate to erythromycin, clindamycin.(6)The probability of infection in ALL children with different gender, the risk level had no statistical significance. Patients with longer hospitalized time or longer duration time of neutropenia had high infection possibility(the former P=0.019, the latter P=0.000). And the lowest platelet counts of patients during induction chemotherapy were negative related with the incidence rate of nosocomial infection (P=0.000), the lowest HGB level of patients had no relationship with the occurrence of infection (P=0.078)(7) Antibiotic and antifungal drugs fees account for20.15%of the total cost in infection group. The non-infection group, antibiotic and antifungal drugs cost accounts for10.69%of the total expenses. The total hospitalization expenses in two groups were difference obviously (P=0.000).Conclusions infection rate of children with ALL receiving induction chemotherapy was high.(2)The infection mostly occurred in respiratory tract, especially in lower respiratory tract.(3)Patients with longer duration time of neutropenia, with the lower platelet counts during induction chemotherapy or with longer hospitalized time had high infection incidence rate. It would be effective to control infection that patient’s using recombinant human granulocyte stimulating factor to promote the growth of granulocyte, and shorten hospital stays.(4)Infection occurred mostly in the third week of the induction chemotherapy phase. Necessary measures should be taken to prevented infection at these times.(5)Gram-negative bacteria were the major pathogen. Most of them were sensitive to antimicrobials such as carbapenems, cefoperazone sodium and sulbactam sodium, Piperacillin Sodium and Tazobactam Sodium, Amikacin. Gram-positive bacteria were sensitive to vancomycin and teicoplanin. Prophylactic antibiotics can be chose according this result.(6) The high cost of anti-infection increase the total hospitalization expenses. To make up individualized therapeutic regimens which combine with the family economic situation and condition of disease can ensure children get economic and effective treatment.