Pathogenic profiles and antimicrobial resistance in neutropenic acute leukemia patients: diagnostic potential of sTNF-R1 and IL-8.

OBJECTIVE

To analyze the etiological characteristics, antimicrobial resistance patterns of infections during the neutropenic phase in acute leukemia (AL) patients, and to evaluate the diagnostic value of soluble tumor necrosis factor receptor 1 (sTNF-R1) and interleukin-8 (IL-8).

METHODS

Clinical data from 142 AL patients in the neutropenic phase, admitted between July 2023 and July 2025, were retrospectively analyzed. Patients were divided into an infected group (n=63) and a non-infected group (n=79) according to the presence of hospital-acquired infections. Pathogen distribution and antimicrobial resistance were assessed in the infected group. Peripheral blood sTNF-R1 and IL-8 levels were measured within 24 hours after confirmed neutropenia and before antimicrobial therapy. Their diagnostic performance for concurrent infections was evaluated using receiver operating characteristic (ROC) curve analysis.

RESULTS

Hospital-acquired infections occurred in 63 patients (44.37%), with bloodstream infections (39.68%) and respiratory tract infections being the most frequent. A total of 71 non-duplicate bacterial strains were isolated, of which 45 (63.38%) were Gram-negative, predominantly Escherichia coli (14 strains, 19.72%), and 26 (36.62%) were Gram-positive, predominantly Staphylococcus aureus (10 strains, 14.08%). High resistance rates were observed to multiple antimicrobials, particularly ampicillin among Gram-negative bacteria and penicillin among Gram-positive bacteria. Compared with the non-infected group, the infected group had higher white blood cell counts, lower albumin levels, and a greater proportion of unfavorable cytogenetic prognosis (all P < 0.05). sTNF-R1 and IL-8 levels were significantly higher in the infected group (both P < 0.001). These biomarkers showed significant negative correlations with neutrophil and albumin levels, and positive correlations with white blood cell count (all P < 0.05). The areas under the ROC curve (AUC) were 0.903 for sTNF-R1 and 0.910 for IL-8 individually, increasing to 0.932 when combined (P < 0.001).

CONCLUSION

Infections during the neutropenic phase in AL patients are predominantly caused by Gram-negative bacteria and exhibit substantial antimicrobial resistance. Elevated sTNF-R1 and IL-8 levels are associated with infection in this population. Combined detection of these biomarkers demonstrates good diagnostic performance and may serve as a useful tool for early screening of infections.