血清降钙素原在儿童血流感染治疗中的应用价值
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摘要
目的分析血清降钙素原(PCT)在儿童血流感染抗感染治疗中的应用价值。方法分别检测79例血流感染患儿血培养送检第1、4、7天的PCT,并收集其临床资料。结果共分离出革兰阳性菌37例,革兰阴性菌42例。血培养送检第1天革兰阳性菌和革兰阴性菌PCT水平分别为7.56(5.33～13.49)ng/mL、8.96(5.36～21.34)ng/mL(P>0.05),第4天分别下降至1.10(0.42～3.62)ng/mL、3.41(1.54～9.95)ng/mL(P<0.05),第7天PCT水平分别下降至0.13(0.10～0.34)ng/mL、0.23(0.12～1.92)ng/mL (P<0.05)。不同病原菌PCT水平下降速度不一致,肺炎链球菌下降速度较快,第4天和第7天分别下降了98.57%和99.21%;鲍曼不动杆菌下降速度较慢,第4天和第7天分别下降了33.15%和46.30%。PCT水平的变化与患儿病情转归基本一致。抗菌药物使用时间为17(11.00～22.50)d,革兰阳性菌和革兰阴性菌抗菌药物治疗费分别为206.34(114.00～389.61)元/d和297.29(224.62～502.60)元/d。结论 PCT可以用于评估血流感染治疗中抗菌药物的使用效果。应结合患儿临床实际情况确定使用抗菌药物的时间,并及时调整用药方案,以降低细菌耐药率和不良反应发生率。
Objective To analyze the role of serum procalcitonin(PCT) in the treatment of bloodstream infection in children. Methods Serum PCT of 79 children with bloodstream infection was determined on the 1 st,4 th and 7 th days,respectively,and the clinical data were also collected. Results A total of 37 Gram-positive bacteria and 42 Gram-negative bacteria were isolated. The 1 st day PCT of Gram-positive bacteria and 42 Gram-negative bacteria were 7.56(5.33-13.49) ng/mL and 8.96(5.36-21.34) ng/mL,respectively(P>0.05). On the 4 th day,PCT in the 2 groups decreased to 1.10(0.42-3.62) ng/mL and 3.41(1.54-9.95) ng/mL,respectively(P<0.05).On the 7 th day,PCT decreased to 0.13(0.10-0.34) ng/mL and 0.23(0.12-1.92) ng/mL,respectively(P<0.05).The decreasing rates of PCT differed among different pathogens. Serum PCT of Streptococcus pneumoniae decreased fastly,with 98.57% decreasing on the 4 th day and 99.21% decreasing on the 7 th day,that of Acinetobacter baumannii decreased slowly,with 33.15% and 46.30% decreasing,respectively. The change of PCT was consistent with the prognosis of children. The antibiotic usage time was 17(11.00-22.50) d. The costs of antibiotics for Gram-positive bacteria and Gram-negative bacteria were 206.34(114.00-389.61) Yuan/d and 297.29(224.62-502.60) Yuan/d,respectively. Conclusions PCT can be used to evaluate the treatment ef?ciency of antibiotic therapy for bloodstream infection,to adjust the antibiotic usage time and antibiotic therapy timely,which can reduce drug resistance and adverse reactions.
Objective To analyze the role of serum procalcitonin(PCT) in the treatment of bloodstream infection in children. Methods Serum PCT of 79 children with bloodstream infection was determined on the 1 st,4 th and 7 th days,respectively,and the clinical data were also collected. Results A total of 37 Gram-positive bacteria and 42 Gram-negative bacteria were isolated. The 1 st day PCT of Gram-positive bacteria and 42 Gram-negative bacteria were 7.56(5.33-13.49) ng/mL and 8.96(5.36-21.34) ng/mL,respectively(P>0.05). On the 4 th day,PCT in the 2 groups decreased to 1.10(0.42-3.62) ng/mL and 3.41(1.54-9.95) ng/mL,respectively(P<0.05).On the 7 th day,PCT decreased to 0.13(0.10-0.34) ng/mL and 0.23(0.12-1.92) ng/mL,respectively(P<0.05).The decreasing rates of PCT differed among different pathogens. Serum PCT of Streptococcus pneumoniae decreased fastly,with 98.57% decreasing on the 4 th day and 99.21% decreasing on the 7 th day,that of Acinetobacter baumannii decreased slowly,with 33.15% and 46.30% decreasing,respectively. The change of PCT was consistent with the prognosis of children. The antibiotic usage time was 17(11.00-22.50) d. The costs of antibiotics for Gram-positive bacteria and Gram-negative bacteria were 206.34(114.00-389.61) Yuan/d and 297.29(224.62-502.60) Yuan/d,respectively. Conclusions PCT can be used to evaluate the treatment ef?ciency of antibiotic therapy for bloodstream infection,to adjust the antibiotic usage time and antibiotic therapy timely,which can reduce drug resistance and adverse reactions.
引文
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[2]胡尧.降钙素原在感染性疾病诊断和监测中的应用[J].检验医学,2017,32(3):234-239.
[3]降钙素原急诊临床应用专家共识组.降钙素原(PCT)急诊临床应用的专家共识[J].中华急诊医学杂志,2012,21(9):944-951.
[4]BOUZA E,SOUSA D,MU?OZ P,et al.Bloodstream infections:a trial of the impact of different methods of reporting positive blood culture results[J].Clin Infect Dis,2004,39(8):1161-1169.
[5]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[6]侯伟伟,肖倩茹,江涟,等.血清降钙素原作为菌血症预示因子临床价值的研究[J].检验医学,2014,29(8):802-805.
[7]PANTELIDOU I M,GIAMARELLOS-BOURBOULIS E J.Can procalcitonin monitoring reduce the length of antibiotic treatment in bloodstream infections?[J].Int J Antimicrob Agents,2015,46(Suppl 1):S10-S12.
[8]BOUADMA L,LU TC E,TUBACH F,et al.Use of procalcitonin to reduce patients'exposure to antibiotics in intensive care units(PRORATA trial):a multicentre randomised controlled trial[J].Lancet,2010,375(9713):463-474.
[9]SULLIVAN S M,VON RUEDEN K T.Using procalcitonin in septic shock to guide antibacterial therapy[J].Dimens Crit Care Nurs,2016,35(2):66-73.
[10]MERMEL L A,ALLON M,BOUZA E,et al.Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection:2009 update by the Infectious Diseases Society of America[J].Clin Infect Dis,2009,49(1):1-45.
[11]国家卫生健康委员会.抗菌药物应用指导原则(2015年版)[EB/OL].(2015-08-27)[2018-02-20].http://www.nhc.gov.cn/cms-search/xxgk/get Manuscript Xxgk.
[2]胡尧.降钙素原在感染性疾病诊断和监测中的应用[J].检验医学,2017,32(3):234-239.
[3]降钙素原急诊临床应用专家共识组.降钙素原(PCT)急诊临床应用的专家共识[J].中华急诊医学杂志,2012,21(9):944-951.
[4]BOUZA E,SOUSA D,MU?OZ P,et al.Bloodstream infections:a trial of the impact of different methods of reporting positive blood culture results[J].Clin Infect Dis,2004,39(8):1161-1169.
[5]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[6]侯伟伟,肖倩茹,江涟,等.血清降钙素原作为菌血症预示因子临床价值的研究[J].检验医学,2014,29(8):802-805.
[7]PANTELIDOU I M,GIAMARELLOS-BOURBOULIS E J.Can procalcitonin monitoring reduce the length of antibiotic treatment in bloodstream infections?[J].Int J Antimicrob Agents,2015,46(Suppl 1):S10-S12.
[8]BOUADMA L,LU TC E,TUBACH F,et al.Use of procalcitonin to reduce patients'exposure to antibiotics in intensive care units(PRORATA trial):a multicentre randomised controlled trial[J].Lancet,2010,375(9713):463-474.
[9]SULLIVAN S M,VON RUEDEN K T.Using procalcitonin in septic shock to guide antibacterial therapy[J].Dimens Crit Care Nurs,2016,35(2):66-73.
[10]MERMEL L A,ALLON M,BOUZA E,et al.Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection:2009 update by the Infectious Diseases Society of America[J].Clin Infect Dis,2009,49(1):1-45.
[11]国家卫生健康委员会.抗菌药物应用指导原则(2015年版)[EB/OL].(2015-08-27)[2018-02-20].http://www.nhc.gov.cn/cms-search/xxgk/get Manuscript Xxgk.