血流感染病原学分析及与相关炎性因子的应用价值研究

Pathogen Analysis of Bloodstream Infection and Study on the Application Value of Related Inflammatory Factors

目的分析血流感染(bloodstream infection,BSI)的病原学特点,并研究与其相关炎性因子的应用价值,为血流感染的诊断与治疗提供依据。方法收集商洛市中心医院2018年1月~2019年11月住院成人患者血培养的结果,回顾性分析阳性血培养的细菌分布特点、科室分布特点及病原菌的耐药情况,然后选取130例血培养阳性病例作为实验组,185例血培养阴性病例作为对照组,比较两组间白细胞数(WBC)、中性粒细胞数(NEU#)、中性粒细胞/淋巴细胞比值(NLR)、超敏C反应蛋白(hsCRP)和降钙素原(PCT)的水平差异。并运用受试者工作特征曲线(ROC曲线)评价WBC,NUE#,NLR,hsCRP和PCT在血流感染中的诊断效能。结果血培养共检出病原菌340株,其中革兰阴性杆菌171株,占50.29%;革兰阳性球菌146株,占42.94%;真菌13株,占3.82%;其他细菌10株,占2.94%。检出的病原菌居前列的依次是大肠埃希菌、肺炎克雷伯菌、凝固酶阴性葡萄球菌、金黄色葡萄球菌和屎肠球菌。血培养阳性患者主要来源于重症医学科、神经外科、急诊医学科、神经内科及泌尿外科。产超广谱ß-内酰胺酶(ESBLs)的大肠埃希菌和肺炎克雷伯菌检出率分别是67.89%和27.27%,耐甲氧西林金黄色葡萄球菌(MRSA)和耐碳青霉烯类肠杆菌检出率分别为64.5%和0.68%。两组间WBC,NEU#,NLR,hsCRP和PCT水平比较差异均具有统计学意义(Z=-10.538^-7.163,均P<0.05)。PCT,NEU#,NLR,hsCRP和WBC的ROC曲线下面积(AUC)分别是0.849,0.752,0.752,0.751和0.737。结论商洛某三甲医院血流感染病原菌以革兰阴性菌为主,病原菌耐药率较高。PCT,NEU#,WBC,NLR和hsCRP均可用于血流感染的辅助诊断,但PCT优于其他检验项目。

Objective To analyze the etiological characteristics of bloodstream infection(BSI)and study the application value of inflammatory factors related to it,so as to provide the basis for the diagnosis and treatment of bloodstream infection.Methods Date of blood culture of adult inpatients in Shangluo Central Hospital from January 2018 to November 2019 were collected.The bacterial distribution characteristics,department distribution characteristics and drug resistance of pathogenic bacteria in positive blood culture were analyzed retrospectively.Then 130 cases of positive blood culture were selected as the experimental group,and 185 cases of negative blood culture were selected as the control group,the differences of WBC,NEU#,NLR,hsCRP and serum PCT levels were compared between the two groups.The diagnostic efficacy of WBC,NEU#,NLR,hsCRP and PCT in bloodstream infection was evaluated by ROC.Results 340 pathogenic bacteria were detected in blood culture,including 171 gram-negative bacilli(50.29%),146 gram-positive cocci(42.94%),13 fungi(3.82%)and 10 other bacteria(2.94%).The pathogenic bacteria detected in the forefront were Escherichia coli,Klebsiella pneumoniae,coagulase-negative Staphylococcus,Staphylococcus aureus and Enterococcus faecium.The patients with positive blood culture mainly came from the department of critical medicine,neurosurgery,emergency medicine,neurology and urology.The detection rates of Escherichia coli and Klebsiella pneumoniae producing extended-spectrum beta-lactamase(ESBLs)were 67.89%and 27.27%,respectively.The detcction rate of methicillinresistant Staphylococcus aureus(MRSA)was 61.54%,and the detection rate of carbapenem resistant Enterobacteriaceae was 0.68%.The difference of WBC,NEU#,NLR,hsCRP and PCT between the two groups was statistically significant(Z=-10.538^-7.163,all P<0.05).The AUC of PCT,NEU#,NLR,hsCRP and WBC were 0.849,0.752,0.752,0.751 and 0.737 respectively.Conclusion The main pathogens of bloodstream infection in a tertiary first-class hospital of Shangluo were Gram-negative bacteria and the overall drug resistance rate of pathogens was high.PCT,NEU#,WBC,NLR and hsCRP all can be used for auxiliary diagnosis of bloodstream infection,but PCT is superior to other test items.