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：

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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.	中華醫學會兒科學分會血液學組, 中華兒科雜志編輯委員會. 兒童急性淋巴細胞白血病診療建議(第三次修訂草案). 中華兒科雜志, 2006, 44(5): 392-395.
3.	中華醫學會兒科學分會血液學組, 《中華兒科雜志》編輯委員會. 兒童急性淋巴細胞白血病診療建議(第四次修訂). 中華兒科雜志, 2014, 52(9): 641-644.
4.	中華人民共和國衛生部. 醫院感染診斷標準(試行). 中華醫學雜志, 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.	L?hmann 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.	中國醫師協會急診醫師分會. 中國急診重癥肺炎臨床實踐專家共識. 中國急救醫學, 2016, 36(2): 97-107.
8.	中華醫學會血液學分會, 中國醫師協會血液科醫師分會. 中國中性粒細胞缺乏伴發熱患者抗菌藥物臨床應用指南(2016年版). 中華血液學雜志, 2016, 37(5): 353-359.
9.	王愛紅, 王占聚, 唐英, 等. 急性白血病患者醫院感染危險因素分析. 山東醫藥, 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, 司繼剛. 重組人粒細胞集落刺激因子對化療后中性粒細胞缺乏的有效性和安全性研究. 藥學與臨床研究, 2014, 22(6): 545-547.
14.	中國侵襲性真菌感染工作組. 血液病/惡性腫瘤患者侵襲性真菌病的診斷標準與治療原則(第五次修訂版). 中華內科雜志, 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. 中華醫學會兒科學分會血液學組, 中華兒科雜志編輯委員會. 兒童急性淋巴細胞白血病診療建議(第三次修訂草案). 中華兒科雜志, 2006, 44(5): 392-395.
3. 中華醫學會兒科學分會血液學組, 《中華兒科雜志》編輯委員會. 兒童急性淋巴細胞白血病診療建議(第四次修訂). 中華兒科雜志, 2014, 52(9): 641-644.
4. 中華人民共和國衛生部. 醫院感染診斷標準(試行). 中華醫學雜志, 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. L?hmann 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. 中國醫師協會急診醫師分會. 中國急診重癥肺炎臨床實踐專家共識. 中國急救醫學, 2016, 36(2): 97-107.
8. 中華醫學會血液學分會, 中國醫師協會血液科醫師分會. 中國中性粒細胞缺乏伴發熱患者抗菌藥物臨床應用指南(2016年版). 中華血液學雜志, 2016, 37(5): 353-359.
9. 王愛紅, 王占聚, 唐英, 等. 急性白血病患者醫院感染危險因素分析. 山東醫藥, 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, 司繼剛. 重組人粒細胞集落刺激因子對化療后中性粒細胞缺乏的有效性和安全性研究. 藥學與臨床研究, 2014, 22(6): 545-547.
14. 中國侵襲性真菌感染工作組. 血液病/惡性腫瘤患者侵襲性真菌病的診斷標準與治療原則(第五次修訂版). 中華內科雜志, 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

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