Frequency of bacterial infections in children with acute lymphoblastic leukemia

Abstract

Akutna limfoblastična leukemija (ALL) je najčešća maligna bolest u djece do 15 godina, a učestalost joj je 25%. Petogodišnje preživljenje se postiže u više od 80% oboljelih, no zbog supresije imunološkog sustava tijekom liječenja djeca imaju česte infekcije. Svrha ovog rada je analizirati učestalost, vrstu i vrijeme pojave bakterijskih infekcija kod djece liječene zbog akutne limfoblastične leukemije. Radom je obuhvaćeno 62 djece liječene zbog ALL u Zavodu za hematologiju i onkologiju Klinike za pedijatriju Medicinskog fakulteta i Kliničkog bolničkog centra Zagreb. Liječenje je podijeljeno u pet faza – indukciju, ranu intenzifikaciju, konsolidaciju, reindukciju i održavanje. Najviše infekcija uzrokovano je koagulaza-negativnim stafilokokom, a zatim Pseudomonasom aeruginosa , Streptococcusom viridans, Escherichiom coli, Enterococcusom faecalis i Klebsiellom pneumonije. Najveći broj infekcija se razvio u fazama konsolidacije i reindukcije. Bakterijske infekcije su često uzrok smrtnosti djece liječene zbog akutne limofoblastične luekemije. Spektar bakterija koje uzrokuju infekcije u ovoj skupini bolesnika brzo se mijenja i one postaju rezistentne na mnoge antibiotike. Zbog toga je potrebno redovito prilagođavati smjernice za liječenje infekcija kod imunosuprimiranih bolesnika. Udio infekcija gram-pozitivnim bakterijama u porastu je zbog agresivnih kemoterapijskih protokola i primjene intravaskularnih katetera. Važno je pridržavati se preventivnih mjera pri njezi bolesnika, održavati higijenu kože, usne šupljine, analne regije, te okoline bolesnika.Acute lymphoblastic leukemia (ALL) is the most common malignant disease in children under 15 years, and its frequency is 25%. Long term survival is achieved in more than 80% of the cases, but because of the supression of the imunological sistem the children have frequent infections. The aim of this study was to analyze the frequency, type and time of occurence of infections in children treated for ALL. The study included 62 children treated for ALL at the Division of Hematology and Oncology, Department of Pediatrics, School of Medicine and University Hospital Center Zagreb. The treatment was divided into five phases – induction, early intensification, consolidation, reinduction and maintenance. The most infections were caused by coagulase-negative Staphylococcus, followed by Pseudomonas aeruginosa, Streptococcus viridans, Escherichia Coli, Enterococcus faecalis and Klebsiella pneumoniae. The greatest number of infections occured during the consolidation and reinduction phases. Bacterial infections are a frequent cause of mortality in children treated for acute lymphoblastic leukemia. The spectrum of bacteria causing infections in this group of patients is changing rapidly and they are becoming resistand to many antibiotics. Because of that it is necessary to frequently adjust the guidelines for infection treatment in immunosupressed patients. The proportion of infections caused by gram-positive bacterias is rising because of the agressive protocols for chemotherapy and the use of intravascular catheters. It is important to abide to preventive measures in patient care, to maintain a good hygiene of the skin, oral cavity, anal region and the surrounding of the patient