Background：Acute leukemia is the most common pediatric hematological malignancy.Bloodstream infections （BSIs） are severe complications in these patients during chemotherapy.This study aimed to explore the clinical ...Background：Acute leukemia is the most common pediatric hematological malignancy.Bloodstream infections （BSIs） are severe complications in these patients during chemotherapy.This study aimed to explore the clinical presentation and etiology of BSI,as well as the common sites of infection,and to provide a basis for the rational regarding antibiotic use.Methods：We performed a retrospective chart review of all pediatric patients who had acute leukemia accompanied by a BSI in our hospital from December 2011 to September 2015.All patients were selected based on clinical presentation and had to have at least one positive blood culture for inclusion.The basic clinical characteristics,blood culture results,and antimicrobial susceptibilities were analyzed.Results：All 231 patients had a fever;of them,12 patients continued to have a fever.Twenty-five patients had nonremitting （NR） leukemia,and 206 patients achieved complete remission （CR）.Differences in the duration of fever between the NR and CR groups were significant （9.6 ＆#177; 7.9 vs.5.1 ＆#177; 3.8 days,P =0.016）.One hundred and eighty patients had agranulocytosis.Differences in fever duration between the agranulocytosis and nonagranulocytosis groups were significant （6.2 ＆#177; 5.1 vs.4.1 ＆#177; 2.6 days,P =0.001）.The other sites of infection in these 231 patients were the lung,mouth,digestive tract,and rectum.Blood culture comprised 2635 samples.There were 619 samples,which were positive.Of the 619 positive blood culture samples,59.9% had Gram-negative bacteria,39.3% had Gram-positive bacteria,and 0.8% had fungus.The primary pathogens were Pseudomonas aeruginosa,Enterobactercloacae,Escherichia coli,and Klebsiella pneumoniae.Of these 231 patients,217 patients were cured.The effective treatment ratio was 94%.Conclusions：Gram-negative bacteria were the main pathogenic bacteria in patients with acute leukemia in our center.NR primary illness,agranulocytosis,and drug-resistant pathogenic bacteria were all risk factors for poor prognosis.展开更多
目的分析经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)在急性白血病患者发生导管相关感染(catheter-related infection,CRI)的病原学特点及危险因素,为进一步改善急性白血病患者的CRI提供理论依据。方法...目的分析经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)在急性白血病患者发生导管相关感染(catheter-related infection,CRI)的病原学特点及危险因素,为进一步改善急性白血病患者的CRI提供理论依据。方法回顾性选择2015年1月-2017年11月进行PICC置管的169例急性白血病患者的临床资料,统计患者发生CRI发生率,统计分析患者的性别、年龄、病程时长、PICC置管时间、PICC穿刺次数、化疗次数、是否发生导管相关感染、感染培养及药敏结果等资料,单因素及多因素Logistic回归分析CRI发生的影响因素。结果 169例急性白血病患者置管后有27例发生CRI,感染率为15.98%。共分离培养出57株病原菌,其中革兰阴性菌37株占64.91%,革兰阳性菌18株占31.58%;多因素Logistic回归分析显示,年龄≥60岁、置管时间≥8个月、化疗次数≥7次、PICC穿刺≥3次是导致急性白血病患者进行PICC置管发生CRI的危险因素(P<0.05)。结论急性白血病患者进行PICC置管后发生CRI主要是以感染革兰阴性菌为主,发生CRI的影响因素较多,可以通过针对性预防措施降低医院感染的发生率,对提高临床效果及医疗质量等具有重要意义。展开更多
文摘Background：Acute leukemia is the most common pediatric hematological malignancy.Bloodstream infections （BSIs） are severe complications in these patients during chemotherapy.This study aimed to explore the clinical presentation and etiology of BSI,as well as the common sites of infection,and to provide a basis for the rational regarding antibiotic use.Methods：We performed a retrospective chart review of all pediatric patients who had acute leukemia accompanied by a BSI in our hospital from December 2011 to September 2015.All patients were selected based on clinical presentation and had to have at least one positive blood culture for inclusion.The basic clinical characteristics,blood culture results,and antimicrobial susceptibilities were analyzed.Results：All 231 patients had a fever;of them,12 patients continued to have a fever.Twenty-five patients had nonremitting （NR） leukemia,and 206 patients achieved complete remission （CR）.Differences in the duration of fever between the NR and CR groups were significant （9.6 ＆#177; 7.9 vs.5.1 ＆#177; 3.8 days,P =0.016）.One hundred and eighty patients had agranulocytosis.Differences in fever duration between the agranulocytosis and nonagranulocytosis groups were significant （6.2 ＆#177; 5.1 vs.4.1 ＆#177; 2.6 days,P =0.001）.The other sites of infection in these 231 patients were the lung,mouth,digestive tract,and rectum.Blood culture comprised 2635 samples.There were 619 samples,which were positive.Of the 619 positive blood culture samples,59.9% had Gram-negative bacteria,39.3% had Gram-positive bacteria,and 0.8% had fungus.The primary pathogens were Pseudomonas aeruginosa,Enterobactercloacae,Escherichia coli,and Klebsiella pneumoniae.Of these 231 patients,217 patients were cured.The effective treatment ratio was 94%.Conclusions：Gram-negative bacteria were the main pathogenic bacteria in patients with acute leukemia in our center.NR primary illness,agranulocytosis,and drug-resistant pathogenic bacteria were all risk factors for poor prognosis.
