急性白血病患儿医院感染病原菌及危险因素分析

目的探索白血病患儿医院感染的主要部位、病原菌分布及危险因素,为其医院感染的预防和治疗提供依据。方法收集2011—2012年入住某院儿科的828例急性白血病(AL)化疗患儿的病历资料,分析医院感染病例的感染部位、病原菌分布及医院感染的高危因素。结果 828例AL患儿,发生医院感染184例,196例次,医院感染率为22.22%,例次率为23.67%。感染部位以呼吸系统居多,占52.56%。196例次感染中检出病原菌96株,其中革兰阴性菌56株,占58.33%,革兰阳性菌28株,占29.17%。单因素分析显示处于白血病诱导化疗期、住院时间≥30 d、外周白细胞计数≤3×109/L、粒细胞计数≤0.5×109/L、类型为急性非淋巴细胞白血病(ANNL)是感染发生的高危因素。多因素分析结果显示住院时间≥30 d是医院感染的独立危险因素。结论 AL患儿医院感染发病率较高,其中呼吸系统感染发病率较高,病原菌以革兰阴性菌为主。化疗诱导期、住院时间长、白细胞与中性粒细胞数量低及急性髓性白血病等因素是儿童白血病患者医院感染发生的高危因素。

Pathogens and risk factors of healthcare associated infection in children with acute leukemia

ObjectiveTo explore the main sites, pathogen distribution and risk factors of healthcare associated infections (HAI) in children with acute leukemia, and provide scientific evidence for  prevention and treatment.MethodsData  of 828 children with acute leukemia admitted to a hospital in 2011-2012 were collected, infection site, pathogen distribution and risk factors of infection were analyzed.ResultsOf 828 patients, 184 cases and 196 times of HAI occurred with the incidence of 22.22% and 23.67%, respectively. HAI occurred mostly in respiratory tract (52.56%). A total of 96 pathogenic strains were isolated, among which gram negative and gram positive bacteria accounted for 58.33%(n=56) and 29.17%(n=28) respectively. Univariate analysis revealed that risk factors for HAI were leukemia remission induction chemotherapy,  hospital stay ≥30 days, peripheral leukocyte count (WBC) ≤3×109/L， granulocyte count ≤0.5×109/L, and acute nonlymphocytic leukemia. Multivariate analysis revealed that hospital stay ≥30 days was independent risk factors for HAI.ConclusionChildren with acute leukemia have a high incidence of HAI, infection mainly occurs in respiratory system, and gram negative bacteria are major pathogens. The incidence of HAI is correlated with remission induction chemotherapy,long length of hospital stay, low WBC, low number of neutrophils, and acute myeloid leukemia.