Pathogens,drug resistance and value of Keap1,Nrf2,PD-1,and PD-L1 mRNA in diagnosis of prognosis of acute leukemia patients with bloodstream infection
OBJECTIVE To analyze the distribution and drug resistance of pathogens in acute leukemia(AL)com-plicated with bloodstream infection,and to investigate the diagnostic value of Kelch-like epichlorohydrin-related protein-1(Keap1),nuclear factor E2-related factor-2(Nrf2),programmed cell death receptor-1(PD-1)and pro-grammed cell death ligand-1(PD-L1)messenger RNA(mRNA)in prognosis.METHODS From Jan 2019 to Jul 2023,198 patients with AL complicated with bloodstream infection in Qilu Hospital of Shandong University were enrolled in the study.The distribution of pathogens and the main drug resistance of the pathogens were analyzed.According to the prognosis of the patients 30 days after treatment,they were divided into the death group(29 ca-ses)and survival group(169 cases).The clinical characteristics and Keap1,Nrf2,PD-1,and PD-L1 mRNA levels of the two groups were statistically analyzed.The diagnostic value of Keap1,Nrf2,PD-1,and PD-L1 mRNA for the prognosis of AL complicated with bloodstream infection was analyzed by receiver operating characteristic(ROC)curve analysis.RESULTS Gram-negative bacteria infection accounted for 56.59％,gram-positive bacteria infection accounted for 39.51％,and fungal infection accounted for 3.90％in AL patients complicated with blood-stream infection.The drug resistance of Escherichia coli to meropenem,imipenem,amikacin and ceftazidime was low.The drug resistance rate of Staphylococcus epidermidis to levofloxacin was 14.29％,and to erythromycin was 17.86％.The drug resistance rate of Streptococcus pneumoniae to erythromycin was 55.00％.The mRNA levels of Keap1,Nrf2,and PD-L1 in PMBC of the death group were lower than those in the survival group(P＜0.05),while the mRNA levels of PD-1 were higher than those in PBMC of the survival group(P＜0.05).The ar-ea under the curve(AUC)value and sensitivity of Keap1,Nrf2,PD-1,and PD-L1 mRNA combined detection in prediction of prognosis in patients with AL complicated by bloodstream infection were higher than those of individ-ual detecttion(P＜0.05).CONCLUSION Meropenem,imipenem,and amikacin could be used as the preferred drugs for clinical treatment of gram-negative bacterial bloodstream infections in AL patients,while ciprofloxacin and vancomycin oxacillin,gentamicin and cefazolin could be given priority when the infection related to gram-posi-tive bacteria.The combined detection of Keap1,Nrf2,PD-1,and PD-L1 mRNA could effectively improve the di-agnostic value in the prognosis in patients with AL complicated with bloodstream infection.
Acute leukemiaBloodstream infectionPathogenDrug resistanceKelch-like epichlorohydrin related protein-1Nuclear factor E2-related factor 2Programmed cell death receptor-1Programmed cell death ligand-1Messenger RNAPrognosisDiagnostic value
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