儿童急性白血病合并多重耐药细菌性败血症的临床特征及危险因素分析  

Clinical Characteristics and Risk Factors in Children with Acute Leukemia Complicated with Multiple Drug Resistant Bacterial Septicemia

作　　者：刘丽丽 黄嘉惠 黄明 蓝翔 田川 叶中绿 LIU Li-Li;HUANG Jia-Hui;HUANG Ming;LAN Xiang;TIAN Chuan;YE Zhong-Lyu(Children's Medical Center,Affiliated Hospital of Guangdong Medical University,Zhanjiang 524000,Guangdong Province,China)

机构地区：[1]广东医科大学附属医院儿童医学中心,广东湛江524000

出　　处：《中国实验血液学杂志》2023年第5期1563-1568,共6页Journal of Experimental Hematology

基　　金：湛江市科技计划攻关项目(2021B01406)。

摘　　要：目的:分析儿童急性白血病合并多重耐药细菌性败血症的临床特征及危险因素。方法:回顾性分析2013年1月至2021年5月收治于广东医科大学附属医院的合并败血症的急性白血病患儿的临床资料,分析其菌群构成及耐药性,并依据药敏结果将患儿分为多重耐药菌(MDRB)组与非多重耐药菌(non-MDRB)组,比较两组患儿临床资料的差异。结果:共108例患儿具有药敏结果,MDRB组47例,其中革兰阳性菌26株,最常见的多重耐药革兰阳性菌为凝固酶阴性葡萄球菌和金黄色葡萄球菌,最常见的多重耐药革兰阴性菌为大肠埃希菌和肺炎克雷伯菌肺炎亚种。与non-MDRB组患儿相比,MDRB组患儿的C反应蛋白水平较高(P<0.001),死亡率较高(P=0.009),初始经验性抗感染有效率较低(P<0.001),且更易并发脓毒性休克(P=0.003)。Logistic分析结果显示,儿童急性白血病合并MDRB性败血症的危险因素为既往有过MDRB感染(OR=6.763,95%CI:1.141-40.092,P=0.035)、感染前粒缺持续时间≥7 d(OR=3.071,95%CI:1.139-8.282,P=0.027)、感染前90 d内曾使用过抗菌药物(OR=7.675,95%CI:1.581-37.261,P=0.011)。结论:儿童急性白血病合并MDRB性败血症的临床特征为炎症反应重、C反应蛋白水平高,易继发脓毒性休克,初始经验性抗感染治疗有效率低,死亡率高。既往有过MDRB感染、感染前粒缺持续时间≥7 d和感染前90 d内曾使用过抗菌药物是儿童急性白血病合并MDRB性败血症的危险因素。Objective:To investigate the clinical characteristics and risk factors of acute leukemia complicated with multi-drug resistant bacterial septicemia in children.Methods:The clinical data of children with acute leukemia complicated with septicemia admitted to the Affiliated Hospital of Guangdong Medical University from January 2013 to May 2021 were retrospectively analyzed.Their flora composition and drug resistance were also analyzed.The children were divided into multi-drug resistant bacteria(MDRB)group and non-multi-drug resistant bacteria(non-MDRB)group according to the drug sensitivity results,and the differences in clinical data between the two group were compared.Results:A total of 108 children had drug sensitivity results,47 cases in the MDRB group,including 26 strians of Gram-positive bacteria(G+),the most common multi-drug resistant G+bacteria were coagulase-negative staphylococci(CoNS)and Staphylococcus aureus,and the most common multi-drug resistant Gram-negative bacteria G-bacteria were Escherichia coli and Klebsiella pneumoniae subspecies pneumoniae.Compared with non-MDRB group,children in MDRB group had higher C-reactive protein(CRP)level and mortality rate(P<0.001,P=0.009),lower initial empirical antiinfection efficiency(P<0.001),and were more likely to have septic shock(P=0.003).Logistic analysis showed that the risk factors of acute leukemia complicated with MDRB septicemia in children were previous MDRB infection(OR=6.763,95%CI:1.141-40.092,P=0.035),duration of agranulocytosis before infection≥7 days(OR=3.071,95%CI:1.139-8.282,P=0.027),and previous use of antimicrobial drugs within 90 days before infection(OR=7.675,95%CI:1.581-37.261,P=0.011).Conclusions:The clinical features of acute leukemia complicated with MDRB septicemia in children include a heavy inflammatory response,significantly elevated CRP,susceptibility to secondary septic shock,low efficiency of initial empirical anti-infective therapy,and high mortality rate.Previous MDRB infection,duration of agranulocytosis before infection≥7

关 键 词：儿童 急性白血病 败血症 多重耐药 

分 类 号：R733.71[医药卫生—肿瘤] R515.3[医药卫生—临床医学]