114例综合ICU血流感染病原学特征及炎症指标现状研究

Study on etiological characteristics and inflammatory indicators of 114 patients with bloodstream infection at comprehensive ICU

目的 探讨综合ICU菌血症的病原学分布、药敏特征及临床预后,常见实验室炎症指标在辅助诊断血流感染中的临床价值。方法 回顾性分析2021年7月27日—2022年10月14日航天中心医院重症医学科住院送检血培养阳性的血流感染患者。按临床预后和病原菌类型分组,对分组后的临床指标进行比较。结果 共纳入114例,男性70例,女性44例,平均年龄71.65岁,60岁以上患者占79.8%。共分离出144株病原菌,其中革兰阴性菌(GNB)72株,革兰阳性菌(GPB)68株,念珠菌4株。单纯GNB感染52例(45.61%)、单纯GPB感染49例(42.98%)、GNB+GPB感染9例(7.89%)、真菌或混合真菌感染4例(3.51%),死亡率分别为40.40%、44.90%、77.8%、75.00%。检出前五位GNB包括肺炎克雷伯杆菌、大肠埃希菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌、铜绿假单胞菌;前五位GPB包括表皮葡萄球菌、屎肠球菌、人葡萄球菌、头状葡萄球菌、金黄色葡萄球菌。死亡组和未愈组患者的住院费用和日均住院费用高于好转组(P<0.05)。死亡组出现血流感染的时间要晚于好转组和未愈组(P<0.05)。死亡组的单核细胞百分比、红细胞计数、血红蛋白计数、红细胞压积、血小板计数、胆碱酯酶均低于好转组,血乳酸水平高于好转组(P<0.05)。GNB感染组的血培养报阳时间、单核细胞百分比、单核细胞绝对值、血小板计数均低于GPB感染组(P<0.05),而中性粒细胞百分比、降钙素原、白细胞介素-6水平均高于GPB感染组(P<0.05)。结论 ICU的血流感染具有病原分布广,死亡率高的特点。病原学检测、治疗时机、抗生素的合理应用在一定程度上影响血流感染患者的临床预后。实验室常见指标,降钙素原、白细胞介素-6、胆碱酯酶等重要检测项目的早期实施可为感染类型的判断及预后提供一定参考价值。

Objective To study on the etiological distribution,drug susceptibility characteristics,laboratory inflammatory indicators and clinical prognosis in patients with bloodstream infection(BSI)at comprehensive ICU.Methods A retrospective analysis was analyzed on 114 BSI patients with blood cultures-positive who were admitted at ICU of Aerospace Center Hospital from July 27,2021 to October 14,2022.The clinical indexes were compared according to the clinical prognosis and pathogen types.Results The average age of 114 patients(70 males and 44 females)was 71.65 years old,and 79.8%of the patients were over 60 years old.A total of 144 strains of pathogenic bacteria were isolated,including 72 strains of Gram-negative bacteria(GNB),68 strains of Gram-positive bacteria(GPB)strains and 4 strains of Candida.There were 52 cases of single GNB infection(45.61%),49 cases of single GPB infection(42.98%),9 cases of both of GNB and GPB infection(7.89%),and 4 cases of fungal or mixed fungal infection(3.51%).The mortality rates in each group were 40.40%,44.90%,77.8%and 75.00%,respectively.The top five GNB were Klebsiella pneumoniae,Escherichia coli,Acinetobacter baumannii,stenotrophomonas maltophilia and Pseudomonas aeruginosa.The top five GPB included Staphylococcus epidermidis,Enterococcus faecium,Staphylococcus hominis,Staphylococcus capitans and Staphylococcus aureus.The hospitalization expenses and average daily hospitalization expenses of patients in the death group(53 patients)and non-recovery group(26 patients)were higher than those in the improvement group(35 patients)(P<0.05).The blood culture test time of BSI in the death group was later than that in both of the improvement group and the non-recovery group(P<0.05).The percentage of monocyte,erythrocyte count,hemoglobin count,hematocrit,platelet count and cholinesterase in the death-group were lower,and the blood lactic acid level was higher as compared with the improvement-group(P<0.05).The time to positivity(TTP),monocyte percentage,monocyte absolute value and platelet count of the GNB infection-group were lower(P<0.05),while the percentage of neutrophil granulocyte,procalcitonin and interleukin-6 levels were higher(P<0.05)compared with the GPB infection-group.Conclusion BSI patients in ICU are characterized by wide distribution of pathogens and high mortality.The clinical prognosis of BSI patients would be affected by early etiological detection and treatment strategies.The implementation of the inflammatory indicators can provide useful value.