Objective: To investigate the clinical features, distribution of pathogenic bacteria, and drug resistance of bloodstream infection in children with acute leukemia.
Methods: Clinical data of 93 blood culture-positive children with acute leukemia from January 2015 to December 2019 in Department of Pediatrics, The Second Hospital of Anhui Medical University were analyzed retrospectively.
Results: In these 93 cases, 78 cases were in the period of neutrophil deficiency. There were 54 Gram-negative bacteria (G-) (58.1%) found through blood culture, and the top 4 strains were Escherichia coli (15.1%), Klebsiella pneumoniae (13.9%), Pseudomonas aeruginosa (6.5%), and Enterobacter cloacae (6.5%). There were 39 Gram-positive bacteria (G+) (41.9%) detected, and the top 4 strains were Staphylococcus epidermidis (10.8%), Streptococcus pneumoniae (6.5%), Staphylococcus hemolyticus (5.4%), and Staphylococcus human (5.4%). Among 74 strains of pathogenic bacteria from acute lymphoblastic leukemia (ALL) children, there were 29 strains of G+ bacteria (39.2%) and 45 strains of G- bacteria (60.8%). While in 19 strains from acute myeloblastic leukemia (AML) patients, G- bacteria accounted for 47.4% and G+ bacteria accounted for 52.6%. In 15 ALL children without neutropenia, G+ bacteria made up the majority of the strains (66.7%). In the 93 strains of pathogenic bacteria, 13 (13.9%) strains were multidrug-resistant. Among them, extended-spectrum β-lactamases accounted for 42.9%, carbapenemase-resistant enzyme Klebsiella pneumoniae 15.4%, and carbapenemase-resistant enzyme Enterobacter cloacae strains 33.3%, which were detected from G- bacteria. While, 13.3% of methicillin-resistant coagulase-negative Staphylococci accounted for 13.3% detected from G+ bacteria, but linezolid, vancomycin, teicoplanin Staphylococcus and Enterococcus resistant were not found. The average procalcitonin (PCT) value of G- bacteria infection was (11.02±20.282) ng/ml, while in G+ infection it was (1.81±4.911) ng/ml, the difference was statistically significant (P<0.05). The mean value of C-reactive protein (CRP) in G- infection was (76.33±69.946) mg/L, and that in G+ infection was (38.34±57.951) mg/L. The prognosis of active treatment was good, and only one case died of septic shock complicated with disseminated intravascular coagulation (DIC) and gastrointestinal bleeding caused by carbapenemase-resistant enzyme enterobacteriaceae.
Conclusion: G- is the major bacteria in acute leukemia children with bloodstream infection, but the distribution of ALL and AML strains is different. G- bacteria dominates in ALL, while G+ bacteria and G- bacteria are equally distributed in AML. Non-agranulocytosis accompanied by bloodstream infections is dominant by G+ bacteria. The mean value of PCT and CRP are significantly higher in G- bacteria infection than in G+ bacteria.
题目: 急性白血病患儿血流感染单中心病原菌分析.
目的: 探讨急性白血病患儿细菌性血流感染的临床特点、病原学分布和耐药情况。方法：回顾性分析安徽医科大学第二附属医院2015年1月至2019年12月93例发生细菌性血流感染的急性白血病患儿临床资料、病原学分布特点、药敏情况及预后。结果：93例患儿中有78例处于粒细胞缺乏期。93株病原菌中以革兰氏阴性菌（G-）为主， 占58.1%（54/93），革兰氏阳性菌（G+）占41.9%（39/93）。G-菌中前4位依次是大肠埃希菌（15.1%）、肺炎克雷伯菌 （13.9%）、铜绿假单胞菌（6.5%）、阴沟肠杆菌（6.5%），G+菌中前4位依次是表皮葡萄球菌（10.8%）、肺炎链球菌（6.5%）、溶血性葡萄球菌（5.4%）、人葡萄球菌（5.4%）。74株急性淋巴细胞白血病病原菌中G-菌占60.8%，G+菌占39.2%；19株急性粒细胞白血病病原菌中G-菌占47.4%、G+菌占52.6%；非粒细胞缺乏伴感染的15例急性淋巴细胞白血病患儿中以G+菌为主（占66.7%）。93株病原菌中耐药菌株占13.9%，G-菌中检出产超广谱β内酰胺酶大肠埃希菌占42.9%，耐碳青霉烯酶肺炎克雷伯杆菌占15.4％，耐碳青霉烯酶阴沟肠杆菌株占33.3％；G+菌中检出耐甲氧西林凝固酶阴性葡萄球菌占13.3%，未检出耐利奈唑胺、万古霉素、替考拉宁葡萄球菌属菌株及肠球菌菌属菌株。G-菌感染降钙素原检测均值为（11.02±20.282）ng/ml，而G+感染均值为（1.81±4.911）ng/ml，比较差异有统计学意义（P<0.05）。G-感染C反应蛋白均值为（76.33±69.946）mg/L，而G+感染均值为（38.34±57.951）mg/L（P<0.05）。给予积极治疗预后良好，仅一例患儿因耐碳青霉烯酶的阿氏肠杆菌感染性休克并发弥散性血管内凝血及消化道出血死亡。结论：急性白血病患儿血流感染以G-为主，但急性淋巴细胞白血病及急性粒细胞白血病菌株分布存在差异，急性淋巴细胞白血病中以G-菌占优势，急性粒细胞白血病中G+菌与G-菌分布相当，非粒细胞缺乏伴血流感染以G+菌占明显优势。降钙素原及C反应蛋白在G-菌感染中均较G+菌感染明显升高。.
Keywords: acute leukemia; bloodstream infection; children; pathogen.