血清降钙素原区分血培养阳性主要致病菌的价值研究

Studying the value of serum procalcitonin in distinguished the main pathogenic bacteria in blood culture

目的:探讨血清降钙素原(PCT)水平在区分血培养阳性主要致病菌中的意义.方法:收集2017年1月~12月血培养阳性并同时送检PCT的患者共462例,血培养应用BacT/Alert 3D全自动检测系统进行培养,用罗氏Cobas e601全自动电化学发光分析仪检测PCT水平.结果:462例血培养阳性标本中,革兰阴性杆菌240例、革兰阳性球菌164例、真菌17例、其他细菌41例,在PCT分组中,除正常组外,其余各组病原菌分布均有显著差异(P<0.05).革兰阴性杆菌PCT异常率显著高于革兰阳性球菌、真菌和其他细菌,差异有统计学意义(χ2=57.753,P<0.001;χ2=6.042,P=0.014;χ2=29.633,P<0.001),而其他三种病原菌间无显著差异.经相关性分析,除真菌外,其余细菌均与PCT水平呈显著相关.革兰阴性杆菌中大肠埃希菌检出率最高,鲍曼不动杆菌的PCT异常率最高;革兰阳性球菌中凝固酶阴性葡萄球菌(CNS)检出率最高,金黄色葡萄球菌的PCT异常率最高.结论:PCT用于区分血培养阳性患者的主要致病菌有一定意义,为血流感染的早期诊断提供参考信息,尽量避免非必要的抗菌药物治疗,防止抗菌药物滥用.

Objective:To investigate the significance of serum procalcitonin(PCT)in distinguished the main pathogenic bacteria in blood culture.Methods:A total of 462 patients with positive blood culture and PCT were collected from January to December 2017.The blood culture was cultured by BacT/Alert 3D automatic detection system and PCT was detected by Roche Cobas e601 automatic electrochemiluminescence analyzer.Results!There were 240 cases of Gram—negative bacilli,164 cases of Gram—positive coccus,17 cases of fungi and 41 cases of other bacteria in blood culture positive specimens.In the PCT groups,there were significant differences in the distribution of other bacteria except the nomial group(P<0.05).The positive rate of PCT in Gram—negative bacilli was significantly higher than that in Gram—positive cocci,fungi and other bacteria,the difference was statistically significant(X2=57.753,P<0.001,X2=6.042,P=0.014,X2=29.633,P<0.001),but there was no significant difference between the other three species.The correlation analysis showed that all bacteria except fungi had significant correlation with PCT.Among Gram—negative bacilli,the positive rate of Escherichia coli was the highest,Acinetobacter baumannii had the highest positive rate of PCT;the positive rate of coagulase—negative staphylococcus was the highest in Gram—positive coccus,,and the positive detection rate of PCT in Staphylococcus aureus was the highest.Conclusion:It is useful to distinguish the main pathogenic bacteria in patients with positive blood culture.It can provide reference infomiation for the early diagnosis of blood stream infection,avoid non-essential antimicrobial therapy and prevent the abuse of antibiotics as far as possible.