261例血培养阳性病例的临床诊断及特征

Clinical diagnosis and characteristics of 261 patients with positive blood culture

目的分析261例血培养阳性病例的临床诊断及特征,探讨常用临床指标在不同系统疾病中对其血培养结果进行临床诊断的意义。方法对某院2010年10月—2013年2月间血培养阳性的261例住院患者的病历资料进行回顾性分析。结果 261例血培养阳性患者中,204例(78.16%)为菌血症确诊病例,57例(21.84%)为细菌污染病例。临床诊断血培养阳性结果为致病菌的独立相关因素,在泌尿系统疾病为:年龄≥60岁(OR=8.87,P=0.04)、体温≥39℃(OR=10.98,P=0.03)、导尿管的使用(OR=11.99,P=0.02);在脑血管疾病为:住院时间≥10 d(OR=8.72,P=0.04)、中心静脉导管的使用(OR=5.46,P=0.02);在消化肝胆系统疾病为:意识障碍(OR=10.38,P=0.03)、白细胞计数≥15.0×109/L(OR=5.58,P=0.02)。结论各临床指标在不同系统疾病中对其血培养阳性结果的临床诊断意义各不相同;结合原发疾病特点,合理运用临床指标,对正确评估病原学阳性结果具有重要临床意义。

ObjectiveTo analyze the clinical diagnosis and characteristics of 261 patients with positive blood culture, as well as value of related clinical factors in the diagnosis of bacteremia.MethodsClinical data of 261 patients with positive blood culture in a hospital from October 2010 to February 2013 were analyzed retrospectively.ResultsOf 261 patients, 204（78.16%） cases of bacteremia were confirmed,but positive blood culture of the other cases （57, 21.84%） were confirmed to be caused by contamination of blood specimens. Positive blood culture result was the independent factor for bacteremia, independent factors of bacteremia in several diseases were as follows： in urinary system diseases were age ≥60 years（OR=8.87, P=0.04）, temperature ≥39℃ （OR=10.98, P=0.03） and indwelling urethral catheterization （OR=11.99, P=0.02）; in cerebrovascular diseases were length of hospital stay ≥10 days（OR=8.72, P=0.04） and use of central venous catheter （OR=5.46, P=0.02）;in diseases of gastrointestinal and hepatobiliary system were disorder of consciousness （OR=10.38, P=0.03） and leukocyte count ≥15.0×109/L（OR=5.58, P=0.02）.ConclusionClinical factors in the diagnostic value of positive blood culture are different among various diseases; proper clinical factors combining primary disease characteristics for correct assessment of positive blood culture result has important clinical significance.