血培养和炎症指标对血液透析患者导管相关血流感染的诊断效果研究

Values of blood culture and inflammatory markers in diagnosis of catheter-related bloodstream infection in hemodialysis patients

目的探索血培养和炎症指标对血液透析患者导管相关血流感染的诊断效果。方法选取2013年5月-2017年6月于本院接受治疗的63例血液透析患者为研究对象,根据患者的诊断结果分为两组。32例确诊为双腔导管血流感染的患者为感染组,31例非双腔导管血流感染的患者为非感染组,收集两组患者资料并进行分析,观察其病原菌分布情况,检测血培养和炎症指标。结果感染组血清降钙素原(4.13±1.56)μg/L、肿瘤坏死因子-α(1.96±0.41)ng/mL显著高于非感染组,差异有统计学意义(P<0.05)。感染组共检测出病原菌20株,其中革兰阳性菌12株,革兰阴性菌8株。革兰阳性菌中金黄色葡萄球菌、溶血葡萄球菌、表皮葡萄球菌检出率最高;革兰阴性菌中大肠埃希菌、肺炎克雷伯菌检出率最高,三项指标共同联合检测的灵敏度为87.3%、特异度为92.1%、阳性预测值为93.43%、阴性预测值为91.12%以及诊断准确率为91.23%均显著高于各项指标单独检测(P<0.05)。结论血培养和炎症指标联合检测可显著提高血流感染检测的灵敏度、特异性、阳性检测率、阴性检测率以及检测的准确性,可为临床上判断血液透析患者导管的血流感染情况提供参考。

OBJECTIVE To explore the values of blood culture and inflammatory markers in diagnosis of catheterrelated bloodstream infection in hemodialysis patients.METHODS A total of 63 patients who received hemodialysis in the hospital from May 2013 to Jun 2017 were recruited as the study objects and divided into two groups according to the diagnosis results.Totally 32 patients who were diagnosed with double-lumen catheter-related bloodstream infection were assigned as the infection group,31 patients who were diagnosed with non-double-lumen catheter-related bloodstream infection were assigned as the pulmonary infection group.The clinical data were collected from the two groups of patients,the species of isolated pathogens were observed,the blood culture was performed,and the levels of inflammatory markers were detected.RESULTS The levels of serum procalcitonin and tumor necrosis factor-αof the infection group were respectively（4.13±1.56）μg/L and（1.96±0.41）ng/ml,significantly higher than those of the non-infection group（P〈0.05）.Totally 20 strains of pathogens were isolated from the infection group,12 of which were gram-positive bacteria,and 8 were gram-negative bacteria.The isolation rates of Staphylococcus aureus,Staphylococcus haemolyticus and Staphylococcus epidermidis were the highest among the gram-positive bacteria.The isolation rates of Escherichia coli and Klebsiella pneumoniae were the highest among the gram-negative bacteria.The sensitivity of the joint detection of the three indexes was 87.3%,the specificity 92.1%,the positive predictive value 93.43%,the negative predictive value 91.12%,the accuracy of diagnosis 91.23%,significantly higher than those of the single detection（P〈0.05）.CONCLUSION The blood culture combined with inflammatory markers may remarkably raise the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of diagnosis,which provide guidance for clinical diagnosis of the catheter-related bloodstream infection in the hemodialysis patients.