OBJECTIVE: Over the past 10 years, infection has remained as the main cause of illness and mortality among patients with acute lymphoblastic leukemia (ALL) in chemotherapy. Hospitalized acquired pneumonia (HAP) is the most common infection, especially during induction phase in neutropenia episode. We evaluate the risk factors of HAP during chemotherapy in children with ALL.
METHOD: This case control study evaluated children aged under 18 years old with ALL, undergoing chemotherapy from 2016 to 2018 at Dr. Soetomo Academic General Hospital, Surabaya; grouped into HAP (n=60) and without HAP (n=70). HAP was defined based on WHO criteria, occured after 48 hours admission, confirmed by radiological changes and at least 3 clinical or 2 clinical and 1 laboratory criteria. The risks factors for HAP were gender, age, length of stay, nutritional status, risk stratification, chemotherapy phase, and anemia (hemoglobin level below 10g/dL), neutropenia with absolute neutrophil count less than 500/µL and thrombocytopenia below 50,000/µL. Logistic regression was used for data analysis (p<0.05).
RESULT: In HAP group, most of them were boys (60%; p=0.306) and age less than 5 years old (60%; p=0.004). Children with HAP had longer hospitalization above 14 days (80%; P<0.001), high risk ALL (48% vs 31.4%; OR 25.849; 95%CI 3.288 to 202.242; P=0.002), and during induction phase (80% vs 62.9%; OR 5.987; 95%CI 1.131 to 31.677; P=0.035), when compared to without HAP group, HAP was more prevalent in neutropenic children (75% vs 3%; OR 99.068; 95%CI 13.191 to 744.053; P<0.001) but not for anemia, thrombocytopenia, also nutrition status for moderate to severe malnutrition (71.7% vs 55.7% with p=0.121).
CONCLUSION: HAP was more common in high risk ALL children during induction phase of chemotherapy with neutropenia as a major risk factor.