儿童急性白血病耐碳青酶烯革兰阴性菌感染危险因素及预后分析

背景：耐碳青酶烯革兰阴性菌(CRO)感染近年来呈上升趋势，并与重症感染率和病死率显著相关。 目的：分析CRO感染危险因素及预后，为预防CRO提供依据。 设计：病例对照研究。 方法：回顾性分析上海交通大学医学院附属上海市儿童医院血液肿瘤科2012年1月至2019年12月急性白血病（除外急性早幼粒细胞白血病）化疗后革兰阴性菌感染患儿的临床资料，比较CRO和碳青酶烯类敏感革兰阴性菌(CSO)感染患儿的临床特征、预后因素和重症感染率。 主要结局指标：CRO感染的危险因素和经验性抗感染治疗72 h内重症感染发生率。 结果：91例患儿101例次革兰阴性菌感染数据纳入本研究，CSO组76例次，CRO组25例次；急性淋巴细胞白血病67例次(66.3%)，急性髓系白血病34例次(33.7%)。多变量Logistic分析提示，标本采集前30 d内使用碳青霉烯类药物>10 d(OR=6.201，95%CI：1.339～28.729，P=0.020)是CRO的独立危险因素。经验性抗感染治疗72 h内重症感染率24.7%(25/101)，CRO组（14/25，56.0%）高于CSO组（11/76，14.4%），差异有统计学意义(χ2=17.417，P=0.000)。住院期间死亡5例，均为CRO患儿。 结论：急性白血病患儿CRO感染后重症感染率高。30 d内使用碳青霉烯类药物>10 d是CRO感染的独立危险因素。

Risk factors and prognostic factors for carbapenem-resistant organism in children with acute leukemia

Background: Carbapenem-resistant organism (CRO) infections have been increasing in recent years and associated with significant, severe infection and mortality. Objective: To assess the risk factors and prognosis of CRO infections in children with acute leukemia and to provide reference for its prevention. Design: Case-control study. Methods: The data of in-patients with acute leukemia, except for acute promyelocytic leukemia, infected by CRO or carbapenem-susceptible organism (CSO) were recruited from Department of Hematological Oncology at Children's Hospital of Shanghai, Shanghai Jiaotong University School of Medicine between January 2012 and December 2019 to retrospectively analyze their clinical characteristics, prognosis factors and rate of severe infections. Main outcome measures: Risk factors for CRO infection and the incidence of severe infection within 72-hour of empirical anti-infection treatment. Results: A total of 101 samples (91 patients) with Gram-negative organism infections were included into the study, including 76 CSO and 25 CRO. There were 67 cases of acute lymphoblastic leukemia (66.3%) and 34 cases of acute myeloid leukemia (33.7%). Multivariate logistic analysis indicated that carbapenems used for more than 10 days within 1 month before sample collection (OR=6.201，95%CI：1.339-28.729， P=0.020) was an independent risk factors for CRO. The severe infection rate within 72 hours of empirical anti-infection treatment was 24.7% (25/101), which of the CRO group (14/25, 56.0%) was higher than the CSO group (11/76, 14.4%). The difference was statistically significant (χ2= 17.417, P=0.000). Five cases died during hospitalization, all of whom were children with CRO. Conclusion: Acute leukemia in children had high severe infection rate caused by CRO infections. Carbapenem exposure for more than 10 days within one month prior to infections was an independent risk factor.