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Clinical Analysis of Nosocomial Infection in Patients with Acute Leukemia

Author: LiuXiaoLiang
Tutor: YuanChangJi
School: Jilin University
Course: Clinical
Keywords: acute leukemia nosocomial infection clinical research risk factor
CLC: R733.7
Type: Master's thesis
Year: 2006
Downloads: 128
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Abstract


Acute leukemia (AL) is a kind of malignant clone disease ofhematopoietic stem cell and accompanied by the originalmulti-organ’s infiltration, which mainly because of primitive cells andimmature cells abnormally proliferate in the bone marrow. The maindeath reason of acute leukemia are bleeding and infection. Thesurvival and remission rate are obviously prolonged with the progressof the combined chemotherapy,however .The hematopoietic stemcell transplantation is the only way to cure the disease after thecombined chemotherapy. However, the incidence of nosocomialinfection is still higher because of the low-grade immune functions、the large dose of chemotherapy and the application of theimmunosuppressants. The nosocomial infections are predominantcomplication and one of the main causes of death to the patients withAL. Objective: To investigate the clinical features and high riskfactors what impact the nosocomial infections in patients with acuteleukemia, early identify the patients with acute leukemia who easilyoccur nosocomial infections、improve the individualization of thetreatment and the quality of the survival in patients with acuteleukemia、improve the turnover and extend the period with diseasefree survival. Methods: A retrospective review of the medical recordsof 174 patients with acute leukemia who were diagnosed according tothe clinical symptoms、the imageology、the cell morphology and thepathematology of the tissue from January 1, 2005 to January 1, 2006in our hospital. The patients should have accept at least 1 couse ofchemotherapy and the patients with the complete datas were broughtinto the study. A retrospective review has been carried out from theaspects of the sex、age、incidence of the nosocomial infections、turnover、distribution of bacteria and the sensitivity of pathogenicbacterium. The statistical methods of χ2 test and Logistic regressionanalysis have been taken to analyze the single factors and multiplefactors of NI.Result: ① 113 cases of 174 patients with acute leukemia hadnosocomial infection, the incidence rate is 64.9%, the infection timesrate approximately 100.5%,the mortality is 12.4%. ② The commoninfected part were upper respiratory, lung, septicaemia, oral, andcrissum, and the rate were 27.4%、14.3%、13.1%、12.6% and 11.5%.The mortality rate of septicaemia was high. ③ 41 cases of 90specimens patients have accept pathogenic examine and the most kindof bacteria was Gram-negative bacteria, such as Bacterium coli,Pseudomonas aeruginosa, Klebsiella pneumoniae. Enterococcus,Staphylococcus aureus and Staphylococcus epidermidis are commonkinds of Gram-positive bacteria. The common kind of the fungus wasBlastomyces albicans, most of which was autogenous infection. 5kinds of drug resistant strain have been found, anti-meticillin sodiumStaphylococcus epidermidis, anti-meticillin sodium clottingenzyme-positive Staphylococcus aureus, Bacterium col which canproduce extended spectrum β lactamases and βlactamases-positive Staphylococcus epidermidis. ④ In this study theGram-negative bacterias were sensitivity to meropenem、imipenem、amikacin、ciprofloxacin and ceftazidime, the rate is 95.2%、95.2%、71.4、66.7%、57.1%,but the sensitve rate of the ceftriaxone andcefotaxim were lower than 50%. The sensitivity of the Gram-positivebacteria were vancomycin and teicoplanin, the sensitive rate was91.7%. The second sensitivity was imipenem ,83.3%.The sensitivityof the other antibiotics such as erythromycin、cefazolin and oxacillinwere lower than 50%. The sensitive radio of penicillin was only16.7%. ⑤ The fungous infection rate was 10.8%. Only 4 cases ofthem have not received the treatment of antibiotics, and the rest havereceived the treatment of 1-3 kinds of antibiotics, which meansfungous infection was related to the application of broad-spectrumantibiotic. ⑥ 23 cases of 174 patients had septicaemia, 13.2%, andcases whose ANC <0.5×109/L was 17 cases, ANC >0.5×109/L and<1.0×109/L 3 cases, ANC>1.0×109/L 3 cases. The mortality ratedifference between septicaemia 26.1% (6/23) and non-septicaemia8.9% (8/90) was significance (p<0.05). ⑦ The analysis of the singlefactor showed that the age、type of leukemia、stage of treatment、absolute neutrophil count in peripheral blood 、 lasting time ofagranulocytosis、length of hospitalization were relative to nosocomialinfection (p<0.05), and then the main risks were the absoluteneutrophil count in peripheral blood、lasting time of agranulocytosis、stage of treatment、length of hospitalization and the age according tothe Logistic regression analysis.Conclusion: ① The morbility of nosocomial infection in patientswith acute leukaemia are very high, about 64.9% and the infectiontimes were 175, the rate was approximately 100.5%,the mortality ofinfection was 12.4%. NI was the main complication and reason ofdeath in patients with AL, because it affected the density of thetreatment and physical state. ② The most common parts of infectionwere upper respiratory, lung, septicaemia, oral, and crissum. Themortality rate of septicaemia was higher.When the septicaemia inpatients with AL was suspected,the clinical doctor should choosemeropenem or imipenem as the experience antibiotic treatment at first.③ The etiology of NI showed that the bacterium was the most part ofthem. And the most of the bacteria was the Gram-negative bacteria,the ratio was 51.2%. the others were the Gram-negativebacteria ,29.3%and the fungus,19.5%.④ Suggested the clinical doctorapply for meropenem or imipenem for the first choice to the patientswho were old ,have the agranulocytosis and whose stations werepoorer as the experience antibiotic treatment;However,the amikacinthat was ignored was still sensitive to bacteria and also the price wascheap.It was recommended for use .The penicillin 、semisyntheticpenicillin and cephalosporin of first generation weren’t first choice asthe experience antibiotic treatment because their sensitivity was lower.⑤ The main risks were the absolute neutrophil count in peripheralblood、lasting time of agranulocytosis、stage of chemathrapy、lengthof hospitalization and the age by the Logistic regression analysis. Sowe can control effectively nosocomial infections in patients with ALthrough identifying these high risk factors in order to improve thequality of patient and prolong the survival time.

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CLC: > Medicine, health > Oncology > Hematopoietic and lymphoid neoplasms > Leukemia
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