血清C反应蛋白在判定新生儿血培养污染中的应用

Application of serum C-reactive protein in discrimination of neonatal blood culture contamnation

目的:探讨血清C反应蛋白(CRP)在判定新生儿血培养中污染菌的价值。方法:对2859例住院新生儿进行血培养,并检测血清CRP。对CRP升高的所有血培养阳性患者再次抽血培养。对CRP正常而血培养阳性,也进行再次培养作为对照。分析CRP结果与不同病原菌感染的关系。结果:2859例血培养阳性率9.3%,其中革兰阳性菌占61.0%;以表皮葡萄球菌为主,占63.2%。革兰阴性菌占39.0%,以鲁氏不动杆菌为主,占51.0%;血培养阳性标本中,血清CRP<8 mg/L的革兰阳性菌占44.6%,革兰阴性菌占14.2%,两组差异有统计学意义(P<0.05)。CRP<8 mg/L时,二次血培养革兰阳性菌符合率为1.5%(1/65),阴性菌符合率20.0%(4/20);CRP≥60 mg/L,二次血培养,革兰阳性符合率为80.0%(4/5),阴性菌符合率100.0%(9/9)。结论:血清CRP水平检测有助于鉴别血培养阳性是致病菌还是污染菌,避免临床不必要的使用抗菌药物。

Objective：To investigate and evaluate the application value about c-reactive protein（CRP） level in blood culture bacteria contamination from neonatal.Methods： 2859 hospitalized newborn babies were collected for blood culture and serum CRP detection.Cases with blood culture positive or CRP level increase were carried out a second blood culture,then the relationship between CRP results and various pathogenic infections was analyzed.Results： The blood culture positive rate was 9.3% in 2859 cases,with 61.0% of gram-positive,the primary bacteria was staphylococcus epidermidis about 63.2%.Gram-negative bacteria accounted for 39.0% with lwoffii acinetobacter primarily,accounting for 51.0%.In blood culture positive specimens,when serum CRP8 mg/L,gram-positive bacteria accounted for 44.6%,while gram-negative bacteria accounted for 14.2%,the difference between them had statistical significance（P0.05）,and the coincidence rates of the two blood culture positive in gram-positive bacteria and gram-negative bacteria were 1.5% and 20.0%,which were 80.0% and 100% when CRP≥60 mg/L.Conclusion： The detection of serum CRP level can help identify whether the blood culture is positive pathogenic bacteria or pollution bacteria,avoiding unnecessary use of clinical antimicrobial drugs.