Risk factors of nosocomial infection during induction remission chemotherapy in children with acute lymphoblastic leukemia_West China Medical Journal

Authors：

ZHAO Jiou ,  YUAN Yufang , ZHANG Rongrong , YANG Xiaochun , GAO Haiyan

Department of Pediatrics, Huai’an First Hospital Affiliated to Nanjing Medical University, Huai’an, Jiangsu 223002, P. R. China;

Corresponding author：

YUAN Yufang, Email: 763640367@qq.com

Keywords：

Acute lymphoblastic leukemia; Children; Nosocomial infection; Risk factors

DOI：

10.7507/1002-0179.201902010

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the risk factors of nosocomial infection in children with acute lymphoblastic leukemia during induction remission chemotherapy.Methods The children with acute lymphoblastic leukemia who were admitted to the Department of Pediatrics, Huai’an First Hospital Affiliated to Nanjing Medical University between December 2012 and December 2018 were divided into the infection group (including the severe infection subgroup and the non-severe infection subgroup) and the non-infection group according to whether nosocomial infection occurred during induction and remission chemotherapy. The clinical data of patients were collected. Univariate analysis and multivariate logistic regression were used to analyze the risk factors of nosocomial infection during induction remission chemotherapy in children with acute lymphoblastic leukemia.Results A total of 96 patients were included. There were 67 cases in the infection group (26 in the severe infection subgroup and 41 in the non-severe infection subgroup) and 29 cases in the non-infection group. Univariate analysis showed that the granulocyte deficiency time and the prevalence of skin and mucosal damage in the infection group were significantly higher than those in the non-infection group, and the infection group had significantly lower laminar bed use and serum albumin level than the non-infection group did (P< 0.05). Multivariate logistic regression analysis showed that prolonged agranulocytosis [odds ratio (OR)=23.075, 95% confidence interval (CI) (3.682, 144.617), P=0.001], skin and mucosal lesions [OR=12.376, 95%CI (1.211, 126.507), P=0.034], hypoalbuminemia [OR=5.249, 95%CI (1.246, 22.113), P=0.024] were independent risk factors for nosocomial infection during induction and remission of childhood acute lymphoblastic leukemia, while laminar bed [OR=0.268, 95%CI (0.084, 0.854), P=0.026] was the protective factor.Conclusions Long-term agranulocytosis, skin and mucosal lesions, and hypoalbuminemia are independent risk factors for nosocomial infection in children with acute lymphoblastic leukemia during induction remission chemotherapy. Laminar flow bed is its protective factor.

Citation： ZHAO Jiou, YUAN Yufang, ZHANG Rongrong, YANG Xiaochun, GAO Haiyan. Risk factors of nosocomial infection during induction remission chemotherapy in children with acute lymphoblastic leukemia. West China Medical Journal, 2019, 34(4): 370-374. doi: 10.7507/1002-0179.201902010 Copy

1.	Hijiya N, van der Sluis IM. Asparaginase-associated toxicity in children with acute lymphoblastic leukemia. Leuk Lymphoma, 2016, 57(4): 748-757.
2.	中华医学会儿科学分会血液学组, 中华儿科杂志编辑委员会. 儿童急性淋巴细胞白血病诊疗建议(第三次修订草案). 中华儿科杂志, 2006, 44(5): 392-395.
3.	中华医学会儿科学分会血液学组, 《中华儿科杂志》编辑委员会. 儿童急性淋巴细胞白血病诊疗建议(第四次修订). 中华儿科杂志, 2014, 52(9): 641-644.
4.	中华人民共和国卫生部. 医院感染诊断标准(试行). 中华医学杂志, 2001, 81(5): 314-320.
5.	World Health Organization. WHO handbook for reporting results of cancer treatment. Geneva, Switzerland: WHO Offset Publication, 1979: 1-46. https://www.sciencedirect.com/science/article/pii/0197245680900094.
6.	Løhmann DJA, Asdahl PH, Abrahamsson J, et al. Associations between neutrophil recovery time, infections and relapse in pediatric acute myeloid leukemia. Pediatric Blood Cancer, 2017, 65(9): e27231.
7.	中国医师协会急诊医师分会. 中国急诊重症肺炎临床实践专家共识. 中国急救医学, 2016, 36(2): 97-107.
8.	中华医学会血液学分会, 中国医师协会血液科医师分会. 中国中性粒细胞缺乏伴发热患者抗菌药物临床应用指南(2016年版). 中华血液学杂志, 2016, 37(5): 353-359.
9.	王爱红, 王占聚, 唐英, 等. 急性白血病患者医院感染危险因素分析. 山东医药, 2011, 51(27): 97-98.
10.	Sun Y, Huang H, Chen J, et al. Invasive fungal infection in patients receiving chemotherapy for hematological malignancy: a multicenter, prospective, observational study in China. Tumor Biol, 2015, 36(2): 757-767.
11.	Ma LM, Yang HP, Yang XW, et al. Methionine synthase A2756G polymorphism influences pediatric acute lymphoblastic leukemiarisk: a meta-analysis. Biosci Rep, 2019, 39(1): pii: BSR20181770.
12.	Inaba H, Pei D, Wolf J, et al. Infection-related complications during treatment for childhood acute lymphoblastic leukemia. Ann Oncol, 2017, 28(2): 386-392.
13.	李波, 曹原, 司继刚. 重组人粒细胞集落刺激因子对化疗后中性粒细胞缺乏的有效性和安全性研究. 药学与临床研究, 2014, 22(6): 545-547.
14.	中国侵袭性真菌感染工作组. 血液病/恶性肿瘤患者侵袭性真菌病的诊断标准与治疗原则(第五次修订版). 中华内科杂志, 2017, 56(6): 453-459.
15.	Liang R, Chen GY, Fu SX, et al. Benefit of oral nutritional supplements for children with acute lymphoblastic leukaemia during remission-induction chemotherapy: a quasi-experimental study. Asia Pac J Clin Nutr, 2018, 27(1): 144-147.
16.	Wolf J, Tang L, Flynn P, et al. Levofloxacin prophylaxis during induction therapy for pediatric acute lymphoblastic leukemia. Clin Infect Dis, 2017, 65(11): 1790-1798.

1. Hijiya N, van der Sluis IM. Asparaginase-associated toxicity in children with acute lymphoblastic leukemia. Leuk Lymphoma, 2016, 57(4): 748-757.
2. 中华医学会儿科学分会血液学组, 中华儿科杂志编辑委员会. 儿童急性淋巴细胞白血病诊疗建议(第三次修订草案). 中华儿科杂志, 2006, 44(5): 392-395.
3. 中华医学会儿科学分会血液学组, 《中华儿科杂志》编辑委员会. 儿童急性淋巴细胞白血病诊疗建议(第四次修订). 中华儿科杂志, 2014, 52(9): 641-644.
4. 中华人民共和国卫生部. 医院感染诊断标准(试行). 中华医学杂志, 2001, 81(5): 314-320.
5. World Health Organization. WHO handbook for reporting results of cancer treatment. Geneva, Switzerland: WHO Offset Publication, 1979: 1-46. https://www.sciencedirect.com/science/article/pii/0197245680900094.
6. Løhmann DJA, Asdahl PH, Abrahamsson J, et al. Associations between neutrophil recovery time, infections and relapse in pediatric acute myeloid leukemia. Pediatric Blood Cancer, 2017, 65(9): e27231.
7. 中国医师协会急诊医师分会. 中国急诊重症肺炎临床实践专家共识. 中国急救医学, 2016, 36(2): 97-107.
8. 中华医学会血液学分会, 中国医师协会血液科医师分会. 中国中性粒细胞缺乏伴发热患者抗菌药物临床应用指南(2016年版). 中华血液学杂志, 2016, 37(5): 353-359.
9. 王爱红, 王占聚, 唐英, 等. 急性白血病患者医院感染危险因素分析. 山东医药, 2011, 51(27): 97-98.
10. Sun Y, Huang H, Chen J, et al. Invasive fungal infection in patients receiving chemotherapy for hematological malignancy: a multicenter, prospective, observational study in China. Tumor Biol, 2015, 36(2): 757-767.
11. Ma LM, Yang HP, Yang XW, et al. Methionine synthase A2756G polymorphism influences pediatric acute lymphoblastic leukemiarisk: a meta-analysis. Biosci Rep, 2019, 39(1): pii: BSR20181770.
12. Inaba H, Pei D, Wolf J, et al. Infection-related complications during treatment for childhood acute lymphoblastic leukemia. Ann Oncol, 2017, 28(2): 386-392.
13. 李波, 曹原, 司继刚. 重组人粒细胞集落刺激因子对化疗后中性粒细胞缺乏的有效性和安全性研究. 药学与临床研究, 2014, 22(6): 545-547.
14. 中国侵袭性真菌感染工作组. 血液病/恶性肿瘤患者侵袭性真菌病的诊断标准与治疗原则(第五次修订版). 中华内科杂志, 2017, 56(6): 453-459.
15. Liang R, Chen GY, Fu SX, et al. Benefit of oral nutritional supplements for children with acute lymphoblastic leukaemia during remission-induction chemotherapy: a quasi-experimental study. Asia Pac J Clin Nutr, 2018, 27(1): 144-147.
16. Wolf J, Tang L, Flynn P, et al. Levofloxacin prophylaxis during induction therapy for pediatric acute lymphoblastic leukemia. Clin Infect Dis, 2017, 65(11): 1790-1798.

West China Medical Journal

Risk factors of nosocomial infection during induction remission chemotherapy in children with acute lymphoblastic leukemia

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content