血培养阳性报警时间对金黄色葡萄球菌血流感染患者预后的预测价值

Value of time to positivity of blood cultures in predicting the prognosis of patients with bloodstream infection caused by staphylococcus aureus

目的探讨血培养阳性报警时间(TTP)对金黄色葡萄球菌(SAU)血流感染预后的预测价值。方法收集中国人民解放军空军总医院2013年1月—2016年6月血培养结果为SAU感染患者的临床资料及TTP值,用ROC曲线分析TTP在预测患者预后中的价值。结果共纳入符合标准且资料完整的SAU血流感染患者63例,低TTP组(TTP≤21 h)32例,高TTP组(TTP>21 h)31例。MRSA感染高TTP组24例,低TTP组10例,比较发现,MRSA感染更易发生于高TTP组(P<0.05),原发感染灶来源于呼吸道高TTP组10例,低TTP组3例,发生率多见于高TTP组(P<0.05),迁徙性感染灶及经验性敏感抗生素治疗例数分别为19、28例vs 10、16例,低TTP组大于高TTP组(均P<0.05)。住院期间病死率的比较,高TTP组大于低TTP组(P<0.05)。TTP>21 h、脓毒症及休克是患者住院期间死亡的独立危险因素。ROC曲线表明,TTP≥21.375 h是预测患者住院期间死亡的最佳切点,曲线下面积(AUC)为0.713,TTP预测的准确度为中等。结论高TTP增加了SAU血流感染患者的病死率,TTP预测的准确度为中等。

Objective To investigate the value of time to positivity of blood cultures(TTP)in predicting the prognosis of patients with blood stream infection caused by staphylococcus aureus(SAU).Methods The clinical data and TTP of patients with SAU bloodstream infection from January 2013 to June 2016 in Air Force General Hospital were collected.Receiver-operating-characteristic(ROC)was used to analyze the diagnostic value of TTP in predicting the source and prognosis.Results Totally 63 concluded clinical data who met the enrolling criteria were enrolled,including 32 cases in the low TTP group and 31 cases in the high TTP group.There were 24 cases in the high TTP group with MRSA infection and 10 cases in the low TTP group with MRSA infection.It was found that MRSA infection was more likely to occur in the high TTP group(P<0.05).There were 10 cases of high TTP group with infections originated from respiratory tract and 3 cases of low TTP group with infections originated from respiratory tract,the incidence rate of primary infection in the respiratory tract was higher in the high TTP group(P<0.05).The migratory lesions and empirically sensitive antibiotics treatment in the low TTP group have 19 cases,28 cases,respectively,which were higher than those in the high TTP group(19 cases,28 cases,respectively)(all P<0.05).Hospitalization mortality rate in the high TTP group was higher than that in the low TTP group(P<0.05).TTP>21 h,sepsis and shock were independent risk factors for death during hospitalization.The ROC curve showed that TTP≥21.375 h is the best cut-point for predicting patient death during hospital stay,the area under the curve(AUC)is 0.713,the accuracy of the TTP prediction is moderate.accuracy of TTP prediction was moderate.Conclusions Higher TTP increased the mortality of SAU bloodstream infection and the accuracy was medium.