139例儿童血流感染的临床分析及炎症指标在鉴别儿童血流感染菌属中的应用价值

Clinical analysis of 139 children with bloodstream infection and value of inflammatory factors in identifying bacteria typesof bloodstream infection

目的对139例儿童血流感染进行临床分析,研究炎症指标在鉴别儿童血流感染菌属中的应用价值。方法回顾性分析2014年6月至2020年5月在厦门市儿童医院住院的139例血培养阳性的血流感染患儿的临床资料,根据血培养病原菌种属分为革兰氏阳性菌组(GP组,n=76)和革兰氏阴性菌组(GN组,n=63),分析病原菌分布,比较两组患儿的临床特点及炎症指标[白细胞(WBC)、C-反应蛋白(CRP)、降钙素原(PCT)]。结果GP组以肺炎链球菌、表皮葡萄球菌多见,GN组以嗜麦芽假单胞菌、大肠埃希菌多见。GN组PCT、CRP水平均显著高于GP组(P<0.05),两组WBC计数比较差异无统计学意义。受试者工作特征(ROC)分析显示,PCT、CRP、WBC、PCT和CRP联合检测及三者联合检测的曲线下面积(AUC)分别为0.74、0.61、0.42、0.69、0.7,PCT、CRP的最佳截断值分别为1.01μg/L、17.7 mg/L。结论儿童血流感染病原菌以肺炎链球菌、嗜麦芽假单胞菌、表皮葡萄球菌、大肠埃希菌多见,PCT对鉴别儿童血流感染菌属具有较高的预测价值。

Objective To analyze the clinical characteristics of 139 children with Bloodstream infection,and study the value of inflammatory factors in identifying bacteria types of bloodstream infection.Methods The clinical data of 139 children with blood culture-positive bloodstream infection hospitalized in Xiamen Children's Hospital from June 2014 to May 2020 were retrospectively analyzed.According to the species of blood culture-positive bacteria,they were divided into Gram-positive bacteria group(GP group,n=76)and Gram-negative bacteria group(GN group,n=63),and the distribution of pathogenic bacteria was analyzed.The clinical characteristics and inflammatory indicators(white blood cells[WBC],C-reactive protein[CRP],procalcitonin[PCT])of the two groups were compared.Results The main pathogens were Streptococcus pneumoniae,Staphylococcus epidermidis,Pseudomonas maltophilia,Escherichia coli.The PCTlevel and CRP level in the GN group were significantly higher than those in the GP group(P<0.05),there was no significant difference in WBC count between the two groups.ROC analysis showed that the area under the curve(AUC)of PCT,CRP,WBC,PCT and CRP combined detection and the three combined detection were 0.74,0.61,0.42,0.69,0.70.The cut-off value of PCT was 1.01μg/L,and CRP 17.70 mg/L.Conclusion The main pathogens of Bloodstream infection in children are Streptococcus pneumoniae,Staphylococcus epidermidis,Pseudomonas maltophilia,Escherichia coli.The PCT level has significant predictive value in identifying bacteria types of Bloodstream infection in children.