血清降钙素原检测在血流感染患者的临床应用

Clinical application of procalcitonin(PCT)in the treatment of patients with bloodstream infections

目的探讨血清降钙素原(PCT)水平与血流感染患者病原菌之间的相关性,为临床早期合理选择抗菌药物提供依据。方法收集2013年1-12月93例血培养阳性患者的临床资料,包括患者血清降钙素原(PCT)、C-反应蛋白(CRP)检测结果,比较PCT水平在革兰阴性菌与革兰阳性菌之间的差异以及各病原菌PCT水平的差异。结果 93例血流感染患者检出革兰阴性菌44株占47.3%,革兰阳性菌感染49株占52.7%;两类病原菌PCT水平中位数分别为12.33、0.56ng/ml,差异有统计学意义(P<0.01);在革兰阴性菌中鲍氏不动杆菌PCT水平与肺炎克雷伯菌比较差异有统计学意义(P<0.05),大肠埃希菌PCT水平与鲍氏不动杆菌比较差异有统计学意义(P<0.05);在革兰阳性菌中肠球菌属PCT水平与酿脓链球菌比较差异有统计学意义(P<0.05),金黄色葡萄球菌PCT水平与肠球菌属比较差异有统计学意义(P<0.05)。结论 PCT水平对血流感染患者病原菌菌种有提示意义,革兰阴性菌感染PCT水平高于革兰阳性菌感染;根据PCT测定水平,早期选择抗菌药物治疗,可降低血流感染病死率;低水平PCT可除外血流感染,减少不必要血培养送检。

OBJECTIVE To investigate the correlation between serum PCT concentrations and bacteria pathogens in the patients with bloodstream infections so as to provide references for early rational use of antibiotics in clinical practices .METHODS The clinical data of 93 patients with positive blood culture from Jan .2013 to Dec .2013 were collected ,including the PCT and CRP levels .The PCT levels were compared between the gram‐negative （G- ） bacteria and the gram‐positive （G＋ ） bacteria and among the various species of pathogens .RESULTS A total of 93 patients with blood stream infection were enrolled and categorized into two different groups ,namely G - bacterial infection group with 44 cases and G＋ bacterial infection group with 49 cases .The median values of PCT level of the two types of pathogens were 12 .33 ng/ml and 0 .55 ng/ml ,respectively .The differences were significant （P〈0 .01） .In G- bacteria ,PCT levels between Acinetobacter baumannii infected patients and Klebsiella pneumoniae infected patients were significant （P〈0 .05） .And PCT levels between E .coli infected patients and A .baumannii infected patients were significant （P〈0 .05） .In G＋ ,PCT level between patients infected with Enterococcus and patients infected withStreptocuccus pyogenes was statistically significant （P〈0 .05） .PCT level between patients infected by Staphylococcus aureus and patients infected with Enterococcuswas significant （ P 〈 0 .05 ） . CONCLUSIONS PCT level can pre‐diagnose the type of pathogenic bacteria infected by patients with blood infec‐tions .PCT level in patients infected by gram‐negative bacteria is higher than those infected by gram‐positive bacte‐ria .In accordance with PCT level ,we can choose antibiotics in an early stage and to reduce fatality rate of blood infections .Low levels of PCT can reduce bloodstream infections and unnecessary blood cultures .