Objective: To explore the clinical features of bloodstream infections (BSI) in children with acute myeloid leukemia (AML) during the first induction chemotherapy. Methods: The clinical data, pathogen of BSI, antibiotic susceptibility in vitro, complications and prognosis of 204 newly diagnosed AML children admitted to Blood Diseases Hospital, Chinese Academy of Medical Sciences from August 2009 to December 2015 were analyzed retrospectively. χ2 test was used for the comparison between groups and Logistic regression was used for BSI risk factor analysis. Results: Among 204 patients, 116 were males and 88 were females. The age was 8 (ranged from 1 to 14) years. Among them, 170 patients received MAE chemotherapies (etoposide, mitoxantrone and cytarabine) and 25 received IAE chemotherapies (etoposide, idarubicin and cytarabine). The other 9 patients used granulocyte colony stimulating factor (G-CSF)-priming regimen (aclacinomycin or homoharringtonine, cytarabine and G-CSF) for induction treatments. A total of 28 patients experienced BSI and the incidence rate was 13.7% (28/204), 26 of them developed BSI once and 2 patients developed twice. Gram-positive bacteria were predominant pathogens accounting for 53.3% (16/30) while gram-negative bacteria accounting for 40.0% (12/30) and fungal accounted for 6.7% (2/30). The most common detected pathogens were Coagulase negative Staphylococcus (CoNS, 26.7% (8/30)), followed by Streptococcus spp. (13.3% (4/30)) and Escherichia coli (13.3% (4/30)). Among Gram-negative bacteria (GNB), 3 cases showed carbapenem resistance and 2 cases were Stenotrophomonas maltophilia. BSI-related mortality was 28.6% (8/28). Infections caused by drug-resistant GNB or fungi resulted in 6 fatal cases. The incidence rate of BSI in group with severe neutropenia was higher than in group without it (16.6% (25/151) vs. 5.7% (3/53), χ²=3.933, P=0.047). Multivariable analysis showed severe neutropenia at the onset of fever was independent risk factor of BSI (OR=4.258,95%CI 1.097-16.524,P=0.036). Conclusions: During the first induction chemotherapy courses, Gram-positive bacteria cause most of the BSI. Drug-resistant bacteria related infection often result in fatal outcomes. Severe neutropenia is a significant risk factor.
目的： 探讨儿童急性髓系白血病首次诱导化疗期间血流感染的临床特点。 方法： 对2009年8月至2015年12月中国医学科学院血液病医院儿童血液病诊疗中心确诊的204例初诊急性髓系白血病患儿进行回顾性分析。采集患儿的临床资料以及血流感染的病原、体外药敏试验结果、合并症以及预后情况。组间比较应用χ2 检验，血流感染的危险因素分析采用Logistic回归分析。 结果： 204例患儿中男116例、女88例，年龄8（1~14）岁。其中接受MAE方案（依托泊苷+米托蒽醌+阿糖胞苷）诱导患儿170例，接受IAE方案（伊达比星+阿糖胞苷+依托泊苷）诱导患儿25例，接受预激方案［阿克拉霉素或高三尖杉酯碱+阿糖胞苷+粒细胞集落刺激因子（G-CSF）］诱导患儿9例。共有28例患儿发生血流感染，发生率为13.7%，其中26例患儿发生1次血流感染，2例患儿发生2次血流感染。病原谱中革兰阳性菌占53.3%（16/30），革兰阴性菌占40.0%（12/30），真菌占6.7%（2/30）。最常见的病原菌是凝固酶阴性葡萄球菌（26.7%，8/30），然后依次是链球菌属（13.3%，4/30）和大肠杆菌（13.3%，4/30）。12例革兰阴性菌中有3例为碳青霉烯耐药阴性菌，有2例为嗜麦芽窄食单胞菌。共有8例患儿（28.6%，8/28）因血流感染死亡，其中6例感染病原为耐药革兰阴性菌或真菌。严重中性粒细胞缺乏患儿血流感染发生率高于无严重粒细胞缺乏患儿［16.6%（25/151）比5.7%（3/53）， χ²=3.933， P=0.047］。多因素分析显示，发热时伴随严重的中性粒细胞缺乏（OR=4.258，95%CI 1.097~16.524，P=0.036）是血流感染的危险因素。 结论： 在儿童急性髓系白血病首次诱导化疗过程中，血流感染以革兰阳性菌为主，耐药菌感染预后差，严重粒细胞缺乏是显著危险因素。.