降钙素原对儿童不同类型病原菌血流感染的诊断价值
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摘要
目的:探讨降钙素原(PCT)对儿童不同类型病原菌血流感染的诊断价值。方法:收集2014-01—2019-01进行血培养和PCT检测的398例血流感染患儿的临床资料。分析血培养及PCT检测结果,采用受试者工作特征曲线(ROC)评价PCT对血流感染患儿不同类型病原菌的诊断价值。结果:①398例血流感染患儿血培养阳性306例,阳性率为76.88%;血培养阴性92例,占23.12%。②306例血培养阳性患儿检出菌包括革兰氏阴性菌137株(44.77%)、革兰氏阳性菌149株(48.69%)、真菌20株(6.54%),分别以肺炎克雷伯菌、表皮葡萄球菌、白色假丝酵母菌最为多见。PCT水平最高为鲍氏不动杆菌,其次为肠杆菌和大肠埃希菌。③不同病原菌组PCT水平差异有统计学意义(P<0.05)。革兰氏阳性菌组、革兰氏阴性菌组、真菌组PCT水平显著高于血培养阴性组(均P<0.05),革兰氏阴性菌组PCT水平显著高于革兰氏阳性菌组、真菌组(均P<0.05)。④革兰氏阳性菌组与革兰氏阴性菌组在不同PCT水平的分布差异有统计学意义(均P<0.05)。PCT诊断革兰氏阴性菌血流感染的曲线下面积为0.826,革兰氏阳性菌为0.596。PCT截断值为1.187 ng/mL时,敏感度为0.667,特异度为0.819,漏诊率为26.7%,约登指数为0.486,诊断效能较高。结论:PCT对儿童革兰氏阴性菌引起的血流感染的诊断价值较高,最佳截断值为1.187 ng/mL。
Objective:To discuss the diagnostic value of procalcitonin(PCT)in children with different types of pathogen bloodstream infection. Method:A total of 398 children with bloodstream infection performed blood culture and PCT test in First Hospital of Qinhuangdao from January 2014 to January 2019 were analyzed retrospectively.Blood culture and PCT detection results were analyzed,and ROC was used to evaluate the diagnostic value of PCT for different types of pathogens in children with bloodstream infection. Result:①Blood culture was positive in 306 of 398 cases,with a positive rate of 76.88%,and blood culture was negative in 92 cases,accounting for 23.12%.②Among 306 patients with bloodstream infection,137 strains of gram-negative bacteria(44.77%),149 strains of gram-positive bacteria(48.69%),and 20 strains of fungi(6.54%)were detected in blood culture,among which klebsiella pneumoniae,staphylococcus epidermidis,and candida albicans were the most common.The highest PCT level was acinetobacter baumannii,followed by enterobacter and escherichia coli.③The PCT levels of different pathogen groups were statistically different(P<0.05).The PCT level of gram-positive bacteria group,gram-negative bacteria group and fungi group was significantly higher than that of the blood culture negative group(P<0.05),and the PCT level of gram-negative bacteria group was significantly higher than those of gram-positive bacteria group and fungi group(P<0.05).④The distribution of gram-positive bacteria and gram-negative bacteria in different PCT levels was statistically different(P<0.05).The AUC of PCT diagnosis of gram-negative and gram-positive bacteria bloodstream infection was 0.826 and 0.596,respectively.When the cut-off value of PCT was 1.187 ng/mL,the sensitivity,specificity,rate of missed diagnosis and and the Jordan index was 0.667,0.819,26.7% and 0.486 respectively,indicating high diagnostic efficiency.Conclusion:PCT might have a high diagnostic value for blood stream infection caused by gram-negative bacteria in children,and the optimal cut-off value might be 1.187 ng/mL.
Objective:To discuss the diagnostic value of procalcitonin(PCT)in children with different types of pathogen bloodstream infection. Method:A total of 398 children with bloodstream infection performed blood culture and PCT test in First Hospital of Qinhuangdao from January 2014 to January 2019 were analyzed retrospectively.Blood culture and PCT detection results were analyzed,and ROC was used to evaluate the diagnostic value of PCT for different types of pathogens in children with bloodstream infection. Result:①Blood culture was positive in 306 of 398 cases,with a positive rate of 76.88%,and blood culture was negative in 92 cases,accounting for 23.12%.②Among 306 patients with bloodstream infection,137 strains of gram-negative bacteria(44.77%),149 strains of gram-positive bacteria(48.69%),and 20 strains of fungi(6.54%)were detected in blood culture,among which klebsiella pneumoniae,staphylococcus epidermidis,and candida albicans were the most common.The highest PCT level was acinetobacter baumannii,followed by enterobacter and escherichia coli.③The PCT levels of different pathogen groups were statistically different(P<0.05).The PCT level of gram-positive bacteria group,gram-negative bacteria group and fungi group was significantly higher than that of the blood culture negative group(P<0.05),and the PCT level of gram-negative bacteria group was significantly higher than those of gram-positive bacteria group and fungi group(P<0.05).④The distribution of gram-positive bacteria and gram-negative bacteria in different PCT levels was statistically different(P<0.05).The AUC of PCT diagnosis of gram-negative and gram-positive bacteria bloodstream infection was 0.826 and 0.596,respectively.When the cut-off value of PCT was 1.187 ng/mL,the sensitivity,specificity,rate of missed diagnosis and and the Jordan index was 0.667,0.819,26.7% and 0.486 respectively,indicating high diagnostic efficiency.Conclusion:PCT might have a high diagnostic value for blood stream infection caused by gram-negative bacteria in children,and the optimal cut-off value might be 1.187 ng/mL.
引文
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[13] Arai T,Ohta S,Tsurukiri J,et al.Procalcitonin levels predict to identify bacterial strains in blood cultures of septic patients[J].Am J Emerg Med,2016,34:2150-2153.
[2] 吴钦良,嵇金陵,张小云.血清降钙素原动态检测对脓毒血症诊断和预后的应用价值分析[J].临床血液学杂志,2018,31(12):901-903.
[3] Mandragos E,Pistiki A,Tsangaris I,et al.Survival after multiple traumas is associated with improved outcomes from gram-negative sepsis:clinical and experimental evidence[J].J Infect,2017,74:163-171.
[4] van der Geest PJ,Mohseni M,Nieboer D,et al.Procalcitonin to guide taking blood cultures in the intensive care unit;a cluster-randomized controlled trial[J].Clin Microbiol Infect,2017,23:86-91.
[5] Liang SY.Sepsis and other infectious disease emergencies in the elderly[J].Emerg Med Clin North Am,2016,34:501-522.
[6] Brady M,Cunney R,Murchan S,et al.Klebsiella pneumoniae bloodstream infection,antimicrobial resistance and consumption trends in Ireland:2008 to 2013[J].Eur J Clin Microbiol Infect Dis,2016,35:1777-1785.
[7] Mollar A,Miňana G,Villanueva MP,et al.Utility of procalcitonin for diagnosis of superimposed infections in patients with acute heart failure[J].Rev Cardiovasc Med,2016,17:144-148.
[8] Alba GA,Truong QA,Gaggin HK,et al.Diagnostic and prognostic utility of procalcitonin in patients presenting to the emergency department with dyspnea[J].Am J Med,2016,129:96-104.
[9] 胡滨,张源达,臧晓陵.降钙素原在临床科室的应用情况分析[J].临床血液学杂志,2017,30(10):789-791.
[10] Park BS,Kim SE,Park SH,et al.Procalcitonin as a potential predicting factor for prognosis in bacterial meningitis[J].J Clin Neurosci,2017,36:129-133.
[11] Yan ST,Sun LC,Jia HB,et al.Procalcitonin levels in bloodstream infections caused by different sources and species of bacteria[J].Am J Emer Med,2017,35:579-583.
[12] 朱翔,许芳,武其文.降钙素原在脓毒血症患者早期诊断及预后评估中的意义[J].临床血液学杂志,2016,29(6):970-971.
[13] Arai T,Ohta S,Tsurukiri J,et al.Procalcitonin levels predict to identify bacterial strains in blood cultures of septic patients[J].Am J Emerg Med,2016,34:2150-2153.