Investigate the Characteristics of Nosocomial Infections in Patients with Acute Leukemia and Expression of TLR4mRNA TLR2mRNA
|Keywords||Acute leukemia Infection Toll-like receptor Bacterial resistance Risk factor|
Objective To investigate the characteristics of nosocomial infections in patients with AL, risk factor and expression of TLR4mRNA,ILR2mRNA in the peripheral blood cell,provide new way for treatment of nosocomial infections in patients with AL.Methods(1)Explore 560 patients with AL admitted between March,2005 and March,2007. 274 cases were regarded as nosocomial infection group,the other 286 cases without any infection as non-nosocomial infection group,bacterial identification and antimicrobial suscepubility testing were done,the data were analyze with univariateχ~2 test and multivariate logistic-regression model.(2)The mRNA expression of TLR4,TLR2 gene were detected in 18 Gram.negative infections and 18 Gram positive infections patients with AL and 23 patients with AL controls by semi-quantitative reverse transcriptase-polymerase chain reaction(RT-PCR), useingβ-actin as internal reference.Results(1)Among the 286 isolates from 274 AL patients,mainly respiratory tract,blood and stool infecuon,Gram positive were 159(55.6%)and Gram negative were 127(44.4%). Klebsiella bneumoniae was sensitive to Cefepime.resistance rates was 8.1%.Acinetobacter baumannii was sensitive to Imipenem and Cefoperazone+Sulbactam,resistance rates were 8% and 11.1%.Pseudomonas aeurginosa was sensitive to Meraopenem and Ciprofloxacin,resistoance rates were 4.8%.The results showed that age,absolute neutrophil count in peripheral blood, length of hospital stay were risk factors of nosocomial infection.(2)TLR4mRNA expression in the patients with AL Gram negative infections were higher than Gram positive infections patients and were not infections of the patients with AL(p＜0.01).But there was no significant difference in the level of TLR2 mRNA between either the Gram negative infections or the Gram positive infections patients and were not infections of the patients with AL(P＞0.05).Conclusion(1)The prevalence of nosocomial infection in patients with acute leukemia is high.The opportunistic pathogens are the main offenders of nosocomial infections in patients with AL,most of which are resistant to antibiotics,the feature is multidrug resistance.The data have great significance for the empirical use of antimicrobial agents.(2)The results showed that the increased expression levels of TLR4mRNA from the Gram negative infectious patients are associated with Gram negative infections,detection of TLR4mRNA expression may be a method of diagnosis for Gram negative infections in the early stage.