Correlational analysis of procalcitonin levels between gram-positive and gram-negative bloodstream infection
-
摘要: 目的 探讨已使用抗菌药物的血流感染患者血清降钙素原（procalcitonin，PCT）水平与病原菌的相关性。 方法 回顾性收集苏州大学附属第一医院2011年9月至2016年12月住院患者使用抗菌药物过程中同一时刻行PCT检测和血培养，且培养结果为单一病原菌的血流感染患者，对其血培养结果与PCT水平进行相关性分析。 结果 共有119例患者符合入组标准，其中G+菌37例（31.1%），PCT浓度为0.49（0.16~1.59）ng/ml，G-菌82例（68.9%），PCT浓度为0.71（0.27~2.74）ng/ml，G+菌和G-菌PCT水平无显著性差异（P=0.109）。G+菌中以肠球菌属的PCT浓度最高，为3.35（0.95~28.79）ng/ml，G-菌中以肠杆菌属的PCT浓度最高，为5.25（0.22~35.89）ng/ml，不同菌属感染的PCT水平存在显著性差异（P=0.001）。 结论 对于已使用抗菌药物的血流感染患者，血清PCT水平无法判断是G+菌还是G-菌感染。Abstract: Objective To investigate the relationship between procalcitonin (PCT) levels and bacteria in patients with bloodstream infection who were already administered antimicrobial therapy. Methods Retrospective collected the patients with monomicrobial bloodstream infection who were already administered antimicrobial therapy in First Hospital Affiliated to Soochow University from Sept. 2011 to Dec. 2016. Blood samples for PCT testing and culture were collected at the same time. Correlational analysis of PCT levels and bacteria was performed. Results 119 patients were in accordance with the inclusive criteria. 37 patients(31.1%)were infected with gram-positive(G+) bacteria and 82 patients(68.9%)were infected with gram-negative(G-) bacteria.The median (interquartile range, IQR) of PCT were 0.49 (0.16-1.59) ng/ml and 0.71 (0.27-2.74) ng/ml for G+ and G- infection, respectively (P=0.109). Enterococcus and enterobacter had the highest PCT levels among G+ and G- bacteria, the median (IQR) of PCT were 3.35(0.95-28.79) ng/ml and 5.25 (0.22-35.89) ng/ml, respectively. PCT levels in different cohorts existed significant differences (P=0.001). Conclusion For patients with bloodstream infection who were already administered antimicrobial therapy, PCT levels were unable to distinguish G- from G+ bacteria.
-
Key words:
- bloodstream infection /
- blood culture /
- procalcitonin /
- antibacterias
-
[1] 《抗菌药物临床应用指导原则》修订工作组. 抗菌药物临床应用指导原则(2015年版)[M].北京:人民卫生出版社, 2015:62-63. [2] 万学红, 卢雪峰. 诊断学[M]. 8版. 北京:人民卫生出版社, 2013:456. [3] 杨朵, 张曼. 重症监护病房细菌性血流感染监测中C反应蛋白和降钙素原的临床意义[J]. 中国感染与化疗杂志, 2014, 14(1):29-31. [4] 严宏. 血培养革兰阳性与阴性菌感染患者血清降钙素原水平的比较[J]. 中国实验诊断学, 2015, 19(4):627-629. [5] 胡方启, 程贤高, 丁丹, 等. 儿童脓毒症血培养结果与血清降钙素原关系分析[J]. 临床儿科杂志, 2015, 33(4):326-329. [6] 林海焕, 莫泽珣, 陈珍, 等. 降钙素原在区分血培养阳性主要致病菌中的意义[J]. 广东医学, 2016, 37(16):2445-2447. [7] 林贵兰, 马晓波, 逯晓辉, 等. 血培养阳性患者降钙素原、白细胞介素6的差异性分析[J]. 中华医院感染学杂志, 2017, 27(3):532-534, 549. [8] 韩小娟, 伦瑞花, 张轩. 血清降钙素原对血流感染病原菌的鉴别诊断[J]. 中华医院感染学杂志, 2017, 27(10):2186-2189. [9] 刘丽疆, 郭宇芳. 血清降钙素原水平对血流感染患者病原菌的诊断价值[J]. 基因组学与应用生物学, 2017, 36(4):1331-1335. [10] 张有江, 王欢, 罗燕萍, 等. 定量降钙素原测定在血流感染诊断中的应用[J]. 军医进修学院学报, 2010, 31(12):1219-1221. [11] 吴志恒, 郭玉霞, 卜婧, 等. 革兰阴性菌和革兰阳性菌血流感染危重患者中致炎症反应的比较[J]. 中国感染与化疗杂志, 2012, 12(1):27-31. [12] 高红梅, 路玲, 王勇强, 等. 对116例革兰阳性和阴性菌脓毒症患者临床特征及预后的分析[J]. 中国急救医学, 2014, 34(3):197-202. [13] BOUSSEKEY N, LEROY O, GEORGES H, et al. Diagnostic and prognostic values of admission procalcitonin levels in community-acquired pneumonia in an intensive care unit[J]. Infection, 2005, 33(4):257-263. [14] CHARLES PE, LADOIRE S, AHO S, et al. Serum procalcitonin elevation in critically ill patients at the onset of bacteremia caused by either gram-negative or gram-positive bacteria[J]. BMC Infect Dis, 2008, 8:38-45. [15] LELI C, FERRANTI M, MORETTI A, et al. Procalcitonin levels in gram-positive, gram-negative, and fungal bloodstream infections[J]. Dis Markers, 2015,2015:701480. [16] BRODSKá H, MALí KOVá K, ADáMKOVá V, et al. Significantly higher procalcitonin levels could differentiate gram-negative sepsis from gram-positive and fungal sepsis[J]. Clin Exp Med, 2013, 13(3):165-170. [17] GUO SY, ZHOU Y, HU QF, et al. Procalcitonin is a marker of gram-negative bacteremia in patients with sepsis[J]. Am J Med Sci, 2015, 349(6):499-504. -
点击查看大图
计量
- 文章访问数: 2451
- HTML全文浏览量: 223
- PDF下载量: 345
- 被引次数: 0
下载:
