Abstract:

Objective To investigated the risk factors for pediatric acute leukemia complicated with fungemia. Methods Pediatric acute leukemia patients with blood culture fungus positive from 01/2002 to 06/2014 were taken as fungemia group,from Oncology Center of Beijing Children′s Hospital affiliated to Capital Medical University;While the control group included the patients with same in hospital time, same sex, without fungal infection history and fungemia happened.The sample size was 1:2 for fungemia group to control group. The data of age, morbid state(remission or not),relapse situation,in hospital time,using hormonal chemotherapy regimens or not,neutropenia time and degree, central venous indwelling catheter, using broad-spectrum antibiotics and accompanied with septicemia were collected. Single factor and multiple-factor analyses were used to investigate the risk factors for pediatric acute leukemia complicated with fungemia. Results There were 48 cases in fungemia group,male patients 38, median time of using chemotherapeutics was 98（3-300）d, median age was 5.6（1.4-13.8）years.There were 96 cases in control group, male patients 64, median time of using chemotherapeutics was 201（4-1 080）d, median age was 6.7（1-15）years. ① All 48 cases had fever in fungemia group, median time of fever duration time was 8.6（1-42）d. Median time from admitting to hospital to fungemia was 17.6（1~115）d;② 5 cases were with fungal infection history（10.4%）;7 cases were complicated with organ function failur（14.6%）；10 cases with bacteria septicemia（20.8%）;11 cases died or giving up treatment（22.9%）.③ Cultivating result showed that in 17 cases both candida parapsilosis and tropicalis（35.4%） were positive, in 8 cases candida albicans（16.7%） positive, in 2 cases season and candida （4.2%） positive, and candida glabrata, penicilium, fusarium and trichosporon asahii positive in one case respectively（2.1%）.④ Single-factor analysis showed that morbid state(no remission), neutropenia time>7 days, neutropenia degree<0.5×109·L-1, using broad-spectrum antibiotics and complicating with other organs fungal infection were risk factors of pediatric acute leukemia complicated with fungemia.Multi-factor analysis showed that using broad-spectrum antibiotics was independent risk factors of pediatric acute leukemia with fungemia，OR=28.3(95%CI: 5.9-136.2). Conclusion The main pathogen agent of fungimia was candida,especially non-candida albicans. Using broad-spectrum antibiotics was an independent risk factor of pediatric acute leukemia with fungemia