儿童急性淋巴细胞白血病化疗后并发脓毒症临床分析

摘要

目的：探讨儿童急性淋巴细胞白血病（ALL）化疗后并发脓毒症的临床及病原学特点。方法回顾性分析2008年4月至2014年12月诊断为ALL并以CCLG-ALL 2008方案化疗后并发血培养阳性脓毒症患儿的临床及病原学资料。结果545例诊断ALL并以CCLG-ALL2008方案治疗的患儿中112例（145例次）化疗后并发脓毒症，发生率为20.55%。标危和中危组患儿脓毒症高发于诱导缓解治疗阶段，高危组患儿脓毒症高发于巩固治疗阶段。最常见感染部位是呼吸道。血培养病原菌以革兰阳性菌居多。革兰阳性菌对万古霉素、利奈唑胺、替考拉宁敏感率高，革兰阴性菌对美罗培南、亚胺培南敏感率高。高危型、中心静脉置管、中性粒细胞计数＜0.1×109/L及中性粒细胞缺乏持续时间＞7 d者脓毒症发生率显著升高（P＜0.001）。112例患儿治疗有效率95.17%，脓毒症相关病死率1.28%。结论脓毒症是ALL患儿化疗后的重要并发症及死亡原因之一。%ObjectivesTo investigate the pathogen and clinical features in the pediatric acute lymphoblastic leukemia(ALL) patients with septicemia with positive blood cultures episodes.Methods A total of 145septicemia with positive blood cultures episodes in 112 of 545 pediatric ALL patients since April, 2008 to December, 2014 were included. And the clinical manifestations, morbidity, timing of septicemia, site of infection, pathogen characteristics, drug susceptibility rates, related factors for septicemia, treatment and outcomes were retrospectively analyzed.Results The morbidity of 545 pediatric ALL patientwith septicemia was 20.55%. The septicemia onset was mostly during the induction course in chemotherapy in the Standard risk and Intermediate risk ALL groups, and the consolidation course in chemotherapy in the high risk ALL groups. The infection were the most commonly seen inrespiratory tract and gastrointestinal tract. Among 149 strains of pathogens isolated from the patients, Gram-positive bacteria contribute the 51.68% (77/149) strains while 70 strains (47.98%) were Gram-negative bacteria. The incidence rate of septicemia was signiifcantly increased in the patients of High risk ALL groups, central venous catheter, the neutrophil count below 0.1×109/L and the duration of neutropenia more than 7 days (P< 0.001). The total effective rate of 145 septicemia episodes was 95.17%. Total 7 death cases occurred in 112 of 545 pediatric ALL patients, with the incidence of 1.28%of septicemia-related mortality. Conclusions Septicemia is one of the major complication and cause of mortality during chemotherapy for ALL.