Clinical features and risk factors of invasive fungal infections in children with acute leukemia

Abstract

Objective To analyze the clinical features and risk factors of invasive fungal infections (IFI) in children with acute leukemia. Methods Ninety-six acute leukemia children complicated with IFI admitted in Guangzhou Women and Children’s Medical Center during January 2005 and February 2017 were retrospectively reviewed, and 96 cases of acute leukemia without IFI admitted at the same period were randomly selected as control group. The clinical manifestations of IFI were analyzed, multivariate Logistic regression was used to study risk factors of the complication of IFI in pediatric acute leukemia. Results Among 96 children complicated with IFI, fungus were detected in samples from sputum, bronchoalveolar lavage fluid, or blood in 78 cases, in which 42 cases (43.75%) were oral infection, 36 cases (37.50%) were pulmonary infection. Candida albicans (33.33%, 26/78) was the most commonly isolated pathogen, followed by Candida parapsilosis (20.51%, 16/78) and Candida tropicalis (20.51%, 16/78). Univariate analysis revealed hormone-containing chemotherapy, neutropenia (<0.5×109/L), time duration of neutropenia ≥10 days, usage of carbapenem antibiotics and combined drug administration ≥2 types were associated with fungal infection (P< 0.05 or <0.01). Multivariate Logistic regression showed that the time duration of neutropenia≥ 10 days (OR=11.390, 95%CI 4.145-55.263, P<0.01), usage of carbapenem antibiotics (OR=4.825, 95%CI 1.681-13.842, P<0.01) and hormone-containing chemotherapy (OR=2.220, 95%CI 1.542-8.246, P<0.05) were the independent risk factors of IFI. Conclusion Rational usage of antibiotics and effective measures taken to restore the granulocytes can help to reduce the incidence of IFI in children with acute leukemia. Key words: Leukemia, biphenotypic, acute; Leukemia, myeloid, acute; Fungal infection; Risk factors