Distribution of blood culture pathogens and clinical characteristics in children with acute leukemia complicated with septic shock

Objective To explore the distribution of blood culture pathogens and clinical characteristics in children with acute leukemia complicated with septic shock. Methods Clinical data of 70 acute leukemia children complicated with septic shock who were positive for blood culture were retrospectively analyzed. The pathogenic findings and clinical characteristics of these cases were collected. Results Among 70 children， 44 （62.9%） cases were positive for blood culture. 33 Gram-negative bacteria （GNB）， 12 Gram-positive bacteria （GPB） and 2 fungi were cultured. The most common GNB was Pseudomonas aeruginosa （8/33， 24.2%）， followed by Escherichia coli （6/33， 18.2%）， Stenotrophomonas maltophilia （5/33， 15.2%） and Klebsiella pneumoniae （4/33， 12.1%）. GPB mainly consisted of Staphylococcus epidermidis， Staphylococcus aureus， Staphylococcus haemolyticus and Streptococcus retardans （2/12， 16.7% for each）. Multi-drug resistant organisms （MDRO） accounted for 48.9% （22/45）. Compared with GPB infections， the duration of antibiotic exposure before septic shock was significantly longer in patients with GNB infections （Z = -1.988， P = 0.047）. However， there were no significant differences in the length of hospital stay， duration of neutropenia and fever and site of primary infection before septic shock， vital signs， severity of illness and level of infection indicators at the onset of septic shock， primary treatment， and clinical outcome between two groups （all P > 0.05）. Compared with non-MDRO infected children， the length of hospital stay and the duration of antibiotic exposure before septic shock were significantly longer in MDRO infected children （t = -2.203， P = 0.035; Z = -2.099， P = 0.036）. Multivariate logistic regression analysis indicated that the length of hospital stay before septic shock was independently associated with MDRO infections （P = 0.045， OR = 1.059， 95%CI： 1.001-1.121）. Conclusions GNB are the leading pathogens of blood culture in pediatric acute leukemia complicated with septic shock. No significant difference was observed in the clinical characteristics between children infected with GNB and GPB. The longer the hospital stay， the higher the risk of MDRO infections.