白血病伴中性粒细胞缺乏症住院患儿并发血流感染病原菌及危险因素  

Pathogens isolated from hospitalized leukemia and neutropenia children complicated with bloodstream infection and risk factors

作　　者：王闰平[1] 郑小芬 陈迎秋[1] 陈爱鹉 WANG Run-ping;ZHENG Xiao-fen;CHEN Ying-qiu;CHEN Ai-wu(The Second Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang 325000,China)

机构地区：[1]温州医科大学附属第二医院儿童血液科,浙江温州325000

出　　处：《中华医院感染学杂志》2023年第7期1094-1097,共4页Chinese Journal of Nosocomiology

基　　金：浙江省基础公益研究计划基金资助项目(GF21G020006);温州市科技局科研基金资助项目(Y2020458)。

摘　　要：目的探讨白血病伴中性粒细胞缺乏症患儿住院并发血流感染危险因素。方法选择温州医科大学附属第二医院儿童血液科2017年1月-2022年1月因白血病入院治疗儿童为研究对象,经筛选共纳入140例患儿,根据患儿在院期间是否发生血流感染分为感染组和非感染组。统计患儿住院期间血培养结果及病原菌分布情况。调查并收集所有患儿性别、年龄、白血病类型、初诊白细胞计数、经外周静脉置入中心静脉导管(PICC)、严重中性粒细胞缺乏、腹泻、应用糖皮质激素、化疗阶段、化疗周期等临床资料。结果白血病并粒细胞减少症患儿140例共21例血培养结果阳性,培养出病原菌21株,无混合感染病例。其中革兰阴性菌16株,革兰阳性菌5株。多因素Logistic回归分析结果显示严重中性粒细胞缺乏、腹泻、应用糖皮质激素和化疗周期均为影响白血病并粒细胞减少症患儿是否发生血流感染的危险因素(P<0.05)。结论严重中性粒细胞缺乏、腹泻、应用糖皮质激素和化疗周期是导致白血病伴中性粒细胞缺乏症患儿住院并发血流感染的危险因素。OBJECTIVE To investigate the of risk factors for blood flow infection in hospitalized children with leukemia and neutropenia.METHODS A total of 140 children who were hospitalized for leukemia in the department of pediatric hematologic of the Second Affiliated Hospital of Wenzhou Medical University from Jan 2017 to Jan 2022 were recruited as the study subjects.They were divided into the infected group and the non-infected group according to whether the bloodstream infections occurred during hospital stay.Blood culture and the distribution of pathogenic bacteria in the hospitalized children were analyzed.The clinical data of genders,age,leukemia types,white blood cell count at initial diagnosis,central venous catheter(PICC)placement through peripheral vein,severe neutropenia,diarrhea,glucocorticoid application,chemotherapy stage and chemotherapy cycle were collected.RESULTS Among the 140 leukemia children complicated with neutropenia,21 were positive for culture of blood,21 strains of pathogens were isolated.No case of mixed infection was identified.There were 16 gram-negative bacteria,and 5 gram-positive bacteria.Multivariate logistic regression analysis showed that severe neutropenia,diarrhea,glucocorticoid application and chemotherapy cycle were independent factors for bloodstream infection in the children with leukemia and granulocytopenia(P<0.05).CONCLUSION Severe neutropenia,diarrhea,glucocorticoid use and chemotherapy cycle are risk factors for hospitalization and bloodstream infection in children with leukemia with neutropenia.

关 键 词：白血病 中性粒细胞缺乏症 血流感染 住院患儿 危险因素 病原菌分布 

分 类 号：R733.7[医药卫生—肿瘤]