急性白血病化疗患儿医院感染的影响因素分析及防控策略研究-现代医学

急性白血病化疗患儿医院感染的影响因素分析及防控策略研究

单位：南京医科大学附属儿童医院 313病区血液肿瘤科, 江苏南京 210000

分类号：R733.71

出版年·卷·期（页码）：2024·52·第二期（209-214）

摘要：

目的：探讨急性白血病(AL)化疗患儿医院感染有关影响因素，分析防控策略。方法：选取2020年3月至2022年3月我院收治的AL化疗患儿155例，回顾性分析患儿住院期间医院感染情况及其他相关临床资料。应用单因素与多因素Logistic回归分析探讨AL化疗患儿出现医院感染的影响因素；采用受试者工作特征(ROC)曲线分析多因素Logistic各独立影响因素与联合预测因子对患儿出现医院感染的预测效能；并以交叉验证法检验联合预测因子预测价值。结果：155例AL化疗患儿医院感染发生率为30.97%。多因素Logistic回归分析显示，化疗阶段为诱导缓解期、有皮肤黏膜损害、住院时间长均为患儿出现医院感染的独立危险因素，中性粒细胞计数高、白蛋白水平高均为患儿出现医院感染的独立保护因素(P＜0.05)；ROC曲线分析显示，各独立影响因素(化疗阶段为诱导缓解期、有皮肤黏膜损害、住院时间长、中性粒细胞计数、白蛋白水平高)对患儿出现医院感染均有一定预测效能，曲线下面积(AUC)分别为0.638、0.710、0.813、0.785、0.716；联合预测因子的预测AUC为0.928，标准误为0.022，95%CI 0.884～0.971，约登指数为0.729，P＜0.001；使用交叉验证法检验显示，联合预测因子分类准确率为88.39%。结论：AL化疗患儿医院感染影响因素包括化疗阶段为诱导缓解期、有皮肤黏膜损害、住院时间长、中性粒细胞计数高、白蛋白水平高，且上述因素联合对患儿医院感染的预测效能良好，可为防控对策制定提供指导。

Objective: To explore the influencing factors of nosocomial infection in children with acute leukemia(AL) undergoing chemotherapy, and to analyze the prevention and control strategies. Methods: A total of 155 children with AL undergoing chemotherapy admitted to the hospital from March 2020 to March 2022 were selected, and the nosocomial infection and other related clinical data during hospitalization were retrospectively analyzed.Univariate and multivariate Logistic regression analysis were used to explore the influencing factors of nosocomial infection in children with AL undergoing chemotherapy. The receiver operating characteristic(ROC) curve was used to analyze the predictive efficacy of independent influencing factors and combined predictors of multivariate Logistic on nosocomial infection in children. The predictive value of combined predictors was tested by cross validation. Results: The incidence of nosocomial infection in 155 children with AL undergoing chemotherapy was 30.97%. Multivariate Logistic regression analysis showed that chemotherapy stage as induction remission stage, skin and mucosal damage, and long hospitalization time were independent risk factors for nosocomial infection in children. High neutrophil count and albumin level were independent protective factors for nosocomial infection in children(P＜0.05). ROC curve analysis showed that each independent influencing factor(chemotherapy stage as induction remission stage, skin and mucosal damage, long hospitalization time, high neutrophil count, high albumin level) had certain predictive efficacy for nosocomial infection in children, and area under curve(AUC) were 0.638, 0.710, 0.813, 0.785, 0.716 respectively. The prediction AUC of the combined predictor was 0.928, the standard error was 0.022, 95%CI 0.884-0.971, and the Yoden index was 0.729, P＜0.001. The cross validation test showed that the classification accuracy of joint predictors was 88.39%. Conclusion: The influencing factors of nosocomial infection in children with AL undergoing chemotherapy include chemotherapy stage as induction remission stage, skin and mucosal damage, long hospitalization time, high neutrophil count and albumin level, and the combination of the above factors has a good predictive effect on nosocomial infection in children, which could provide guidance for the formulation of prevention and control countermeasures.

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