感染相关炎症指标在多重耐药菌血流感染早期诊断中的应用分析

Application of infection biomarkers in early diagnosis of multiple resistant bacteria bloodstream infection

目的探讨感染相关炎性指标在鉴别多重耐药菌血流感染及预测病原体类别中的作用。方法回顾性分析852例多重耐药感染病例资料,共有526例同时开展血培养、血常规、C反应蛋白(CRP)、降钙素原(PCT)和胰淀粉样蛋白(SAA)检测的患者病历资料,分析上述指标在血培养阴性、阳性结果组间差异及鉴别血流感染的诊断价值。结果 526例患者中共有108例血培养阳性病例,其中革兰阳性菌感染42例(38.9%),革兰阴性菌感染66例(61.1%)。主要包括23株耐甲氧西林金黄色葡萄球菌(MRSA),39株大肠埃希菌,20株肺炎克雷伯菌。多重耐药菌血培养阳性病例中,革兰阳性菌组CRP、PCT、SAA、中性粒细胞(NEU)与革兰阴性菌组差异均有统计学意义(Z值分别为2.448、5.647、3.368和4.905,P<0.05)。不同革兰阳性菌血流感染患者CRP差异有统计学意义(H=19.021,P<0.001),以MRSA最高。不同革兰阴性菌血流感染CRP和PCT水平差异均有统计学意义(H值分别为19.369和15.013,P<0.01),以超广谱β内酰胺酶阳性大肠埃希菌最高。以多重耐药菌血培养阳性为阳性标准绘制受试者工作特征(ROC)曲线,CRP、PCT、SAA、白细胞(WBC)、NEU曲线下面积(AUC)分别为0.778、0.728、0.658、0.578、0.645,其中CRP、PCT有鉴别能力(P<0.01)。以多重耐药革兰阴性菌为阳性标准绘制ROC曲线,CRP与PCT鉴别AUC分别为0.692和0.883。结论 CRP鉴别多重耐药菌血流感染能力高于PCT。当初步确定血流感染后,PCT更适合鉴别革兰阴性菌血流感染。感染早期联合PCT和CRP有助于医务人员判断多重耐药菌血流感染及可能病原菌种类,及早合理用药。

Objective To evaluate the role of bacterial infection related inflammatory biomarkers in identifying multidrug resistant(MDR) bloodstream infections(BSIs) confirmed by blood culture(BC) and predicting pathogen types.Methods A retrospective analysis was conducted on 852 MDR infection patients in the Third People’s Hospital of Hubei Province,while 526 patients with concurrent laboratory test results including blood culture,routine blood tests,C reaction protein(CRP),procalcitonin(PCT) and serum pancreatic amyloid(SAA).The differences of the above indicators were analyzed in negative blood culture and positive blood culture groups,and the diagnostic value for the bloodstream infections was also evaluated.Results In 526 patients,there were 108 BSIs cases,including 42 cases(38.9%) were infected with Gram-positive bacteria and 66 cases(61.1%) were infected with Gran-negative bacteria.MRSA(23 cases),ESBL-positive Escherichia coli(39 cases) and ESBL-positive klebsiella pneumoniae(20 cases) were the major pathogens in BSIs.In BCpositive cases,there were significant differences in CRP,PCT,SAA and NEU between Gram-negative bacteria group and Gram-positive bacteria group(Z=2.448,5.647,3.368,4.905,all P<0.05).Within cases of Gram-positive bacteria,there was statistical significance in CRP(H=19.021,P<0.001),with the highest level of MRSA(114.35 mg/L).Within cases of Gram-negative bacteria,both CRP and PCT showed statistical significance(H=19.369,15.013,P<0.01),with the highest level in ESBL-positive escherichia coli(164.60 mg/L,97.42-217.50;7.361 μg/L,3.51-9.95).The area under the receiver operating characteristic curves(ROC-AUCs) of CRP,PCT,SAA,WBC and NEU for discriminating positive MDR-BC from MDR-BC negative cases were 0.778,0.728,0.658,0.578,and 0.645,with statistical significance in CRP and PCT(P<0.01).For discriminating Gram-negative bacteria BC,AUCs of CRP and PCT-were 0.692 and 0.883 with statistical significance(P<0.01).Conclusion CRP is more applicable for the early diagnosis of BSI compared with PCT.After confirming BSI,PCT is suitable for discriminating Gram-negative bacteria infection.Therefore,the combination of PCT and CRP may help medical staff to judge the BSI and type the possible pathogens,and to rationally use drugs.