妇产科术后感染患者血病原体培养的研究

Blood culture of patients with postoperative infection in department of gynecology and obstetrics

目的对比妇产科术后感染患者血病原体培养阳性和阴性的实验室指标,为术后血流感染的诊断提供研究依据。方法选取2015年1月-2017年12月于北京大学国际医院就诊的妇产科手术患者4841例为研究对象,对术后感染情况和感染患者血病原体培养结果进行分析,对血培养阴性和血培养阳性患者的外周血白细胞计数(WBC)、中性粒细胞计数(NEU)、中性粒细胞/淋巴细胞比率(NLR)、血小板计数(PLT)及血清C-反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)、IL-17、IL-23、IL-4、IL-10、IL-13、细胞间黏附分子-1(intercellular adhesion moleclar-1,ICAM-1)、血管细胞黏附分子-1(vascular cell adhesion molecule-1,VCAM-1)、嗜酸性粒细胞活化趋化因子-3(eosinophil activation chemokine-3,Eotaxin-3)、单核细胞趋化蛋白-1(monocyte chemotactic protein-1,I MCP-1)水平进行比较。结果妇产科手术患者术后感染率为3.86%(187/4841),感染部位以呼吸道、泌尿道、手术部位为主;血培养阳性率为11.23%(21/187),血培养阳性患者的外周血WBC、NEU、NLR与血清CRP、PCT、IL-6、IL-17、IL-23、IL-4、IL-10、IL-13、ICAM-1、VCAM-1、Eotaxin-3、MCP-1分别为(10.95±9.16)×10^9/L、(9.25±8.07)×10^9/L、(14.23±10.13)和(96.65±45.88)mg/L、(4.06±2.35)ng/ml、(293.88±40.96)ng/ml、(58.82±8.81)ng/ml、(86.08±11.53)pg/ml、(29.62±3.94)ng/ml、(55.06±7.82)ng/ml、(253.35±38.12)pg/ml、(126.08±17.15)ng/ml、(158.04±18.75)ng/ml、(227.41±39.56)ng/ml、(381.16±50.45)ng/ml均高于血培养阴性患者(P<0.05),外周血PLT为(172.28±82.05)×10^9/L低于血培养阴性患者(P=0.045)。结论相对于血培养阴性的患者,血培养阳性的妇产科术后感染患者表现为外周血感染标志物、炎症因子、黏附趋化因子的过表达和凝血功能恶化,机体的炎症反应、免疫失衡和凝血障碍更加严重,对这些实验室指标进行综合性评价,可弥补血培养的局限性,提高针对术后血流感染的诊断效率。

OBJECTIVE To compare the laboratory indicators between the patients with positive blood culture and negative blood culture with postoperative infections in the department of gynecology and obstetrics,so as to provide the basis for the diagnosis of postoperative bloodstream infections.METHODS A total of 4841 cases of gynecological and obstetric surgery patients who visited Peking University International Hospital from Jan.2015 to Dec.2017 were selected as the study subjects.The postoperative infections and the blood culture results of the infected patients were analyzed.The white blood cell count(WBC),the neutrophils count(NEU),the neutrophils/lymphocytes ratio(NLR),the platelet count(PLT)in the peripheral blood and the C reactive protein(CRP),the procalcitonin(PCT),the interleukin(IL)-6,IL-17,IL-23,IL-4,IL-10,IL-13,the intercellular adhesion molecule-1(ICAM-1),the vascular cell adhesion molecule 1(VCAM-1),the eosinophil activated chemotactic factor 3(Eotaxin-3),the monocyte chemoattractant protein-1(MCP-1)levels in the serum between the patients with positive blood culture and negative blood culture were detected and compared.RESULTS The infection rate of the patients was 3.86%(187/4841),and the main infection sites were respiratory tract,urinary tract and surgical site,which accounted for 32.62%,27.27%and 11.23%respectively.The positive rate of blood culture was 11.23%(21/187),and the levels of WBC,NEU,NLR in the peripheral blood and the serum CRP,PCT,IL-6,IL-17,IL-23,IL-4,IL-10,IL-13,ICAM-1,VCAM-1,Eotaxin-3,MCP-1 levels of the patients with positive blood culture with gynecological and obstetric postoperative infections were(10.95±9.16)×10^9/L,(9.25±8.07)×10^9/L,(14.23±10.13)and(96.65±45.88)mg/L,(4.06±2.35)ng/ml,(293.88±40.96)ng/ml,(58.82±8.81)ng/ml,(86.08±11.53)pg/ml,(29.62±3.94)ng/ml,(55.06±7.82)ng/ml,(253.35±38.12)pg/ml,(126.08±17.15)ng/ml,(158.04±18.75)ng/ml,(227.41±39.56)ng/ml and(381.16±50.45)ng/ml,which were significantly higher than those with negative blood culture(P<0.05),and the PLT of peripheral blood was(172.28±82.05)×10^9/L,significantly lower than that of patients with negative blood culture(P=0.045).CONCLUSION Compared with the patients with negative blood culture,the patients with positive blood culture with gynecological and obstetric postoperative infections showed the overexpressions of the infectious markers,the inflammatory factors,the adhesive and chemoattractant factors and the significant deterioration of coagulation function indicators.The inflammatory reactions,the immune imbalance and the coagulation disorders were more serious in the body.Comprehensive evaluation of such laboratory indicators can make up for the limitations of blood culture and improve the diagnostic efficiency of postoperative bloodstream infections.