儿童急性白血病化疗后合并真菌血流感染的临床特征及预后分析

Clinical features and prognosis of children with fungal bloodstream infection following chemotherapy for acute leukemia

摘要:

目的 探讨儿童急性白血病（acute leukemia, AL）化疗后合并真菌血流感染（bloodstream infection， BSI）的临床特征及预后。方法 回顾性选择2015年1月—2023年12月在福建3家医院行AL化疗后合并真菌BSI的23例患儿作为研究对象，对其临床特征及预后进行分析。结果 所有AL患儿化疗后合并真菌BSI的发生率为1.38%（23/1 668）。在发生真菌BSI时，87%（20/23）患儿中性粒细胞缺乏已持续超过1周；临床上均有发热表现，22%（5/23）伴脓毒性休克表现。23例（100%）均有C反应蛋白及降钙素原水平明显升高。外周血培养共检出23株真菌，其中以热带念珠菌（52%，12/23）最为常见。卡泊芬净或米卡芬净联合两性霉素B脂质体治疗有效率较高（75%，12/16），抗真菌疗程中位数为3.0个月。总体病死率为35%（8/23），归因死亡率为22%（5/23）。结论 儿童AL化疗后合并真菌BSI多发生于持续中性粒细胞缺乏，临床表现缺乏特异性，病原菌以热带念珠菌最为常见，抗真菌疗程长，病死率高。

Abstract:

Objective To investigate the clinical features and prognosis of children with fungal bloodstream infection (BSI) following chemotherapy for acute leukemia (AL).Methods A retrospective analysis was performed on 23 children with fungal BSI following chemotherapy for AL in three hospitals in Fujian Province, China, from January 2015 to December 2023. Their clinical features and prognosis were analyzed.Results Among all children following chemotherapy for AL, the incidence rate of fungal BSI was 1.38% (23/1 668). At the time of fungal BSI, 87% (20/23) of the children had neutrophil deficiency for more than one week, and all the children presented with fever, while 22% (5/23) of them experienced septic shock. All 23 children exhibited significant increases in C-reactive protein and procalcitonin levels. A total of 23 fungal isolates were detected in peripheral blood cultures, with Candida tropicalis being the most common isolate (52%, 12/23). Caspofungin or micafungin combined with liposomal amphotericin B had a relatively high response rate (75%, 12/16), and the median duration of antifungal therapy was 3.0 months. The overall mortality rate in the patients with fungal BSI was 35% (8/23), and the attributable death rate was 22% (5/23).Conclusions Fungal BSI following chemotherapy in children with AL often occurs in children with persistent neutrophil deficiency and lacks specific clinical manifestations. The children with fungal BSI following chemotherapy for AL experience a prolonged course of antifungal therapy and have a high mortality rate, with Candida tropicalis being the most common pathogen.