OBJECTIVE To investigate the association of glutathione S-transferase M1 (GSTM1) gene polymorphism with hospital-associated infection in children with acute lymphoblastic leukemia, and to analyze the drug resistance of pathogens and the predictive value of micro-inflammatory state.
METHODS One hundred and fifteen children with acute lymphoblastic leukemia admitted to Qingdao Hospital of Traditional Chinese Medicine from Jan. 2021 to Jan. 2024 were selected as the research subjects, and were divided into 56 cases in the infection group and 59 cases in the non-infection group according to the situation of hospital-associated infection. The pathogenic bacteria and drug sensitivity results of the infected children were analyzed. The GSTM1 gene polymorphism and levels of CD64, procalcitonin (PCT), hypersensitive C-reactive protein (hs-CRP) and amyloid A (SAA) were compared between the two groups. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of CD64, PCT, hs-CRP and SAA for hospital-associated infection in children with acute lymphoblastic leukemia.
RESULTS A total of 72 strains of pathogenic bacteria were detected in 56 children with acute lymphoblastic leukemia hospital-acquired infections, of which 42 strains of gram-negative bacteria accounted for 58.33% and 28 strains of gram-positive bacteria accounted for 38.89%, with Escherichia coli and Staphylococcus aureus predominating. The drug resistance rate of Escherichia coli to ampicillin was more than 90%, and it was sensitive to amikacin. Staphylococcus aureus was highly resistant to penicillin G (100.00%) and sensitive to gentamicin, rifampicin, linezolid and vancomycin. The percentage of distribution of GSTM1 null genotype in the infection group was higher than that in the non-infection group (P=0.012). The levels of CD64, PCT, hs-CRP, and SAA in the infection group were (69.45±20.88) %, (0.71±0.22) ng/ml, (12.26±3.94) mg/L and (117.78±36.57) mg/L, respectively, which were higher than those in the non-infection group (P < 0.05). ROC curve showed that the area under the curve (AUC) of combined detection in the diagnosis of hospital-associated infections in children with acute lymphoblastic leukemia was 0.935, which was higher than that of single detection (P < 0.05), and the sensitivity and specificity of combined detection were 91.07% and 84.75%, respectively.
CONCLUSIONS The levels of CD64, PCT, hs-CRP and SAA are abnormal in children with acute lymphoblastic leukemia conbiined with hospital-associated infections, the combined detection of the four indicators can improve the diagnostic value, and the GSTM1 gene polymorphism is related to hospital-associated infection in children with acute lymphoblastic leukemia.
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