| 摘要: |
| ［摘要］ 目的 探讨预防性使用左氧氟沙星对降低急性淋巴细胞白血病（ALL）患儿CAT疗程期间感染风险的效果。方法 回顾性分析2015年1月至2022年8月安徽医科大学第二附属医院收治的324例初诊ALL患儿的临床资料。以诱导治疗期间未服用左氧氟沙星的264例患儿为对照组，接受预防性服用左氧氟沙星的60例患儿为观察组。比较两组CAT疗程期间血流感染（BSI）、中性粒细胞减少症（FN）、临床记录的感染（CDI）等感染事件的发生率，以及炎性指标水平和抗生素使用情况等。结果 观察组BSI、FN、严重感染、发热、CDI的发生率低于对照组，使用抗生素种类数≥3种、使用头孢菌素和大环内酯类药物的人数比例小于对照组，降钙素原（PCT）水平低于对照组，抗生素使用时间、住院时间短于对照组，差异有统计学意义（P<0.05）。logistic回归分析结果显示，经校正危险度分级、性别、年龄，预防性使用左氧氟沙星可有效降低感染的发生（aOR=2.814，P<0.05）。对照组和观察组最常见的感染均为呼吸道感染，但观察组呼吸道感染的发生率较对照组低，差异有统计学意义（P<0.05）。结论 预防性使用左氧氟沙星可显著降低ALL患儿CAT疗程期间BSI、FN、CDI及严重感染的发生率，减少了头孢菌素及大环内酯类药物的暴露，值得临床推荐。 |
| 关键词: 急性淋巴细胞白血病 左氧氟沙星 预防 感染 |
| DOI：10.3969/j.issn.1674-3806.2023.02.10 |
| 分类号:R 733.71 |
| 基金项目:儿科学与生理学共建项目（编号：2020lckk017）；儿科与免疫学共建项目（编号：2021lckk030）；白求恩医学科学研究基金项目（编号：SCE128EN）；安徽医科大学第二附属医院临床研究培育计划项目（编号：2020LCYB04） |
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Effect of prophylactic levofloxacin on reducing the risk of infection during CAT treatment in children with
acute lymphoblastic leukemia |
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TANG Yun-yun, WANG Ning-ling, LIU Kang-kang, et al.
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Department of Children′ s Hematology-Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei 230000, China
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| Abstract: |
| ［Abstract］ Objective To investigate the effect of prophylactic levofloxacin on reducing the risk of infection during CAT treatment in children with acute lymphoblastic leukemia(ALL). Methods The clinical data of 324 children who were newly diagnosed with ALL and were admitted to the Second Affiliated Hospital of Anhui Medical University from January 2015 to August 2022 were retrospectively analyzed. A total of 264 children who did not take levofloxacin during induction therapy were taken as the control group, and 60 children who received prophylactic levofloxacin were taken as the observation group. The incidence rates of bloodstream infection(BSI), febrile neutropenia(FN), clinically documented infection(CDI), inflammatory indicators and use of antibiotics during CAT treatment were compared between the two groups. Results The incidence rates of BSI, FN, serious infections, fever and CDI in the observation group were lower than those in the control group. The proportion of the patients using the number of antibiotics ≥3, and the proportion of the patients using cephalosporins and macrolides in the observation group were lower than those in the control group, and the level of procalcitonin(PCT) in the observation group was lower than that in the control group. The duration of use of antibiotics and hospital stay in the observation group were shorter than those in the control group. There were statistically significant differences between the two groups(P<0.05). The results of logistic regression analysis showed that use of prophylactic levofloxacin could effectively reduce the incidence of infections after adjustment for risk grade, gender and age(aOR=2.814, P<0.05). The most common infection in the control group and the observation group was respiratory tract infection, but the incidence of respiratory tract infection in the observation group was lower than that in the control group, and the difference was statistically significant(P<0.05). Conclusion The use of prophylactic levofloxacin can significantly reduce the incidence rates of BSI, FN, CDI and serious infections in children with ALL during CAT treatment, and reduce the exposure of cephalosporins and macrolides, which is worthy of clinical recommendation. |
| Key words: Acute lymphoblastic leukemia(ALL) Levofloxacin Prevention Infection |
