The Clinical Features and Antibiotic Selection in Children with Acute Leukemia Complicated by Bloodstream Infections from Multidrug-Resistant Bacteria

Jianming SUN; Yuan LI; Qin SU

Article Contents

Article Navigation > Journal of Kunming Medical University > 2024 >

Jianming SUN, Yuan LI, Qin SU. The Clinical Features and Antibiotic Selection in Children with Acute Leukemia Complicated by Bloodstream Infections from Multidrug-Resistant Bacteria[J]. Journal of Kunming Medical University.

Citation:

PDF( 616 KB)

The Clinical Features and Antibiotic Selection in Children with Acute Leukemia Complicated by Bloodstream Infections from Multidrug-Resistant Bacteria

Dept. of Pharmacy of Kunming Children’s Hospital，Kunming Yunnan 650228，China

Received Date: 2024-07-10
Available Online: 2024-11-09

Abstract

Abstract

Objective To investigate the clinical features, independent risk factors, and antibiotic selection in children with acute leukemia complicated by multidrug-resistant （multiple resistant bacteria, MDR） bloodstream infections. Methods A retrospective analysis was conducted on 101 children with acute leukemia complicated by bacterial bloodstream infections and treated at Kunming Children's Hospital from January 2015 to December 2023. Based on blood culture results, patients meeting the criteria for multidrug-resistant （MDR）, extensively drug-resistant （XDR）, and pandrug-resistant （PDR） were included in the multidrug-resistant group （n = 47）, while the remaining patients were included in the non-multidrug-resistant group （n = 54）. Clinical features, laboratory indicators, and antibiotic selection were recorded for both groups, and the risk factors influencing MDR infections were analyzed. Results The proportion of acute myeloid leukemia （AML） and the percentage of patients with neutropenia lasting≥7 days before the induction chemotherapy were both higher in the MDR group compared to the non-MDR group. Additionally, the levels of hemoglobin （Hb） and platelets （PLT） before fever in the MDR group were lower than those in the non-MDR group, and there was statistically significant difference （P < 0.05）.The results indicated that acute myeloid leukemia, neutropenia lasting≥7 days before induction chemotherapy, Hb < 79 g/L before and after the infection, and PLT < 20×10⁹/L before the infection were independent risk factors for MDR infections （P < 0.05）. Microbiological analysis showed that Gram-negative bacteria were the primary pathogens, with a high resistance rate but sensitivity to carbapenems. Gram-positive bacteria were sensitive to specific antibiotics but showed high resistance to erythromycin. Furthermore, the levels of procalcitonin （PCT） and C-reactive protein （CRP） in the MDR group were higher than those in the non-MDR group, and the proportion of patients transferred to the ICU was significantly higher in the MDR group （P < 0.05）. Conclusion Acute myeloid leukemia, neutropenia lasting≥7 days before the induction chemotherapy, hemoglobin <70 g/L, and PLT < 20×10⁹/L are independent risk factors for multidrug-resistant （MDR） bloodstream infections in children and the factors affecting the prognosis. Escherichia coli is identified as the primary resistant pathogen. Children with MDR infections exhibited the elevated levels of procalcitonin （PCT） and C-reactive protein （CRP）, along with a low recovery rate. Therefore, effective preventive measures should be implemented for high-risk factors, and treatment plans should be promptly adjusted based on antibiotic susceptibility results to improve the efficacy.
- Acute leukemia in children,
- Bloodstream Infection,
- Chemotherapy,
- Multidrug resistance,
- Antimicrobial drug

FullText(HTML)

References(16)

References

[1]	刘松雅,朱莉,王春艳,等. SET-CAN融合基因阳性急性白血病患者的免疫表型及其临床特点分析[J]. 中国实验血液学杂志,2023,31(6):1639-1646.
[2]	Zhang C,Wan W,Zhang S,et al. Treatment patterns and a prognostic scoring system for elderly acute myeloid leukemia patients: A retrospective multicenter cohort study in China[J]. Cancer Biology & Medicine,2022,19(6):871-883.
[3]	Cammarata-Scalisi F,Girardi K,Strocchio L,et al. Oral manifestations and complications in childhood acute myeloid leukemia[J]. Cancers,2020,12(6):E1634-E1634. doi: 10.3390/cancers12061634
[4]	李艳,汪俭,刘洪军,等. 儿童急性白血病伴侵袭性肺部真菌感染的临床特点、真菌分布及影响因素分析[J]. 中国现代医学杂志,2023,33(21):22-26. doi: 10.3969/j.issn.1005-8982.2023.21.004
[5]	王翔,徐煜皓,孙宇,等. 儿童急性淋巴细胞白血病的代谢组学及外显子组学研究[J]. 南京医科大学学报(自然科学版),2024,44(2):197-204,234.
[6]	姚佳峰,李楠,姜锦. 单中心血液肿瘤患儿合并感染病原菌分布及耐药性病例系列报告[J]. 中国循证儿科杂志,2019,14(2):112-117. doi: 10.3969/j.issn.1673-5501.2019.02.007
[7]	高珊,屈丽君,陈天平. 92例儿童急性淋巴细胞白血病首次诱导化疗合并感染临床分析[J]. 安徽医学,2022,43(7):813-816. doi: 10.3969/j.issn.1000-0399.2022.07.016
[8]	Castagnola E,Mesini A,Bagnasco F,et al. Antibiotic resistant bloodstream infections in pediatric patients receiving chemotherapy or hematopoietic stem cell transplant: Factors associated with development of resistance,intensive care admission and mortality[J]. Antibiotics,2021,10(3):1-14.
[9]	杜晓亮,温凯丽,孟月,等. 儿童急性髓系白血病流行病学回顾性分析[J]. 中国病案,2021,22(8):81-84. doi: 10.3969/j.issn.1672-2566.2021.08.030
[10]	谭家乐,杨华强,李红,等. 急性白血病患者化疗后发生院内感染的临床特点[J]. 锦州医科大学学报,2020,41(1):41-46.
[11]	巫一立,余莉华,林丹娜,等. 儿童急性白血病多重耐药菌血流感染的临床特征和高危因素分析[J]. 中国实用儿科杂志,2019,34(5):414-418.
[12]	刘丽丽,黄嘉惠,黄明,等. 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[J]. 中国实验血液学杂志,2023,31(5):1563-1568.
[13]	陈国建,杨洁,邓艾,等. 某综合医院常见多重耐药菌感染危险因素Logistic回归分析[J]. 华西医学,2020,35(3):290-295.
[14]	谢朝云,蒙桂鸾,熊芸,等. 医院多重耐药菌血流感染相关因素Logistic回归分析[J]. 中国消毒学杂志,2019,36(8):606-608,612. doi: 10.11726/j.issn.1001-7658.2019.08.014
[15]	刘斌,向明丽,赵西西. 儿童急性白血病多重耐药菌血流感染的危险因素及对预后的影响[J]. 罕少疾病杂志,2021,28(2):103-104. doi: 10.3969/j.issn.1009-3257.2021.02.043
[16]	刁志英,刘天鉴,钱爱民,等. 降钙素原、C反应蛋白及白细胞计数在诊断新生儿感染中的应用价值[J]. 实用临床医药杂志,2019,23(4):84-86. doi: 10.7619/jcmp.201904025

Relative Articles(20)

Relative Articles

[1]	Caini ZHANG, Ya LI. A Meta-analysis of the Efficacy and Safety of Camrelizumab Combined with Chemotherapy in the Treatment of Non-small Cell Lung Cancer. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20240610
[2]	Jiang WU, Jiang ZHANG, Yanyan FEI, Qin LIU, Yuanjiao CHEN, Yuanxiao WANG, Shuifen DAI. Application of Knowledge-attitude-behavior Continuation in Nursing Education for Nasopharyngeal Cancer Patients After Radiotherapy and Chemotherapy. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20241026
[3]	Jia WANG, Lei FENG, Yulei ZHENG, Yong YUAN, Yao YAO, Zidang HU, Ni SHENG, YUYan, Jiawei DING. Study on the Correlation Between Multiple Drug Resistance of Acinetobacter baumannii with Efflux Pump and Biofilm Formation. Journal of Kunming Medical University,
[4]	Chunyan LIU, Bingqing CHANG, Chao LI, Xin REN, Xiaoqin LIU. Correlations between CD4⁺CD25⁺Treg，sCD30 and Clinical Characteristics of Lymphoma and Their Value in Predicting Infection after Chemotherapy. Journal of Kunming Medical University,
[5]	Jiang WU, Shuifen DAI, Qin LIU, Shoutao YANG, Jiang ZHANG, Jiao YANG, Qiongyao GUAN. Effect of Nutrition Clinical Nursing Pathway for Nasopharyngeal Carcinoma Patients Concurrent Radiotherapy and Chemotherapy. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20230510
[6]	Jiawei LIAO, Xiaoqing HU, Yi YANG. Changes of Thyroid Function and Its Clinical Significance before and after Radiotherapy and Chemotherapy in Patients Undergoing Radical Breast Cancer Treatment. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20220229
[7]	Bo TIAN, Jun LIU, Haiwen LI, Wei SONG, Haiyun CHEN, Jianjun SUN. Pathogen Distribution and Antimicrobial Susceptibility of Bacterial Bloodstream Infection in AIDS Patients. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20220616
[8]	Peng-peng SUN, Zhi-jing LIU, Meng ZHANG, Jing-dong WANG, Sheng ZHANG, Lai-zang WANG, Peng BAI. Effect of Tracheotomy Timing in Patients with Severe Cerebrovascular Disease. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20210816
[9]	Fu-Jun ZHANG, Rong GONG. Significance of Dynamic Monitoring of T Lymphocyte Subsets and NK Cells in Patients with Esophageal Cancer before and after the Surgery and Chemotherapy. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20210935
[10]	Ling ZHOU, Feng-di HU, Rong LI, Ye-dan LIAO, Zheng-qin GENG, Jia-dai TANG, Xue-qi ZHANG, Lin XIE, Zuo-zhang YANG. A Clinical Scoring System Predicting the Osteosarcoma Chemotherapy Drug Resistance. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20210144
[11]	Hai-lin HUANG, Hong-chao JIANG, Xiao-juan LI. Drug Resistance of Escherichia coli and Klebsiella pneumoniae in Children with Bloodstream Infection from 2017 to 2020. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20210817
[12]	Mao Jian , Ren Yu Ji , Dan Bin , Shao Tian Bo . The Distribution and Drug-resistance of Gram-negative Bacilli among Blood Stream Infection in Yunnan Province of China during 2012～2014. Journal of Kunming Medical University,
[13]	Long Xiang Yu . . Journal of Kunming Medical University,
[14]	Wang Yuan Yuan . . Journal of Kunming Medical University,
[15]	Wu Xue Song . . Journal of Kunming Medical University,
[16]	Wang Ruo Tian . . Journal of Kunming Medical University,
[17]	Li Chong Yang . . Journal of Kunming Medical University,
[18]	Hu Li Bing . . Journal of Kunming Medical University,
[19]	Sun Jian Ming . . Journal of Kunming Medical University,
[20]	Duan Xian Meng . . Journal of Kunming Medical University,