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

doi:10.12259/j.issn.2095-610X.S20241119

Volume 45 Issue 11

Nov. 2024

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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, 2024, 45(11): 137-143. doi: 10.12259/j.issn.2095-610X.S20241119

Citation:

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, 2024, 45(11): 137-143. doi: 10.12259/j.issn.2095-610X.S20241119

Citation:

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, 2024, 45(11): 137-143. doi: 10.12259/j.issn.2095-610X.S20241119

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

doi: 10.12259/j.issn.2095-610X.S20241119

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

Received Date: 2024-07-10
Available Online: 2024-11-09
Publish Date: 2024-11-25

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

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