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

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。

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

Objective To evaluate the role of bacterial infection related inflammatory biomarkers in identifying multi-drug 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 BC positive 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