血培养阳性报警时间预测金黄色葡萄球菌血流感染患者的临床特征与预后  

Value of time to positivity of blood cultures in predicting clinical characteristics and prognosis of patients with bloodstream infections caused by Staphylococcus aureus

作　　者：黄磊[1] 孙立颖[1] 严岩[1] 

机构地区：[1]北京大学第一医院检验科细菌室,北京100034

出　　处：《中华医院感染学杂志》2013年第20期5107-5109,5117,共4页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金(81201338)

摘　　要：目的探讨血培养阳性报警时间(TTP)在预测金黄色葡萄球菌(SAU)血流感染患者临床特征与预后中的价值。方法根据预定的入选标准,收集医院2008-2012年血培养分离出SAU感染患者的临床资料及TTP,以最接近TTP中位数的整数为切点,分为低TTP组和高TTP组,对两组患者的临床资料进行统计分析;用logistic回归分析TTP是否为各项指标的独立危险因素,用受试者工作曲线(ROC)分析TTP的诊断价值。结果共纳入符合入选标准且临床资料齐备的患者73例,低TTP组36例,高TTP组37例,在严重脓毒血症及脓毒血症休克、导管相关性感染、住院期间病死率的差异有统计学意义(P<0.05),TTP≤16h是预测严重脓毒血症及脓毒血症休克、导管相关性感染、住院期间病死率的独立危险因素;TTP≤16.72h、≤18.27h和≤13.85h分别为预测其最佳切点,曲线下面积分别为0.763、0.633和0.724。结论低TTP是SAU血流感染患者发生严重脓毒血症及脓毒血症休克、导管相关性感染、预后差的独立危险因素,TTP预测三者的准确度分别为中等、较低、中等。OBJECTIVE To investigate the value of time to positivity （TTP） of blood cultures in predicting clinical characteristics and prognosis of patients with bloodstream infections caused by Staphylococcus aureus. METHODS Based on predetermined enrolling criteria, the clinical data and TTP of the hospitalized patients with biood culture positive for S. aureus from 2008 to 2012 were collected, then the patients were divided into the high TTP group and the low TTP group, with the integer number nearest to the median TTP as the cut-off point. The clinical variables of two groups were compared statistically. Logistic regression analysis was performed to determine whether or not the TTP was an independent risk factor for these variables. Receiver-operating-characteristic （ROC） curves were used to analyze the diagnostic value of TTP. RESULTS Totally 73 patients with intact clinical data who met the enrolling criteria were enrolled, including 36 cases in the low TTP group and 37 cases in the high TTP group ~there were significant differences in the severe sepsis and septic shock, catheter-related infection, and mortality during hospital stay between the low TTP group and the high TTP group （P%0.05）. The TTP less than 16 h was the independent risk factor for the three variables. The TTP less thanl6. 72 h, TTP less than 18.27 h, and TTP less than 13.85 h were the optimal cut-off points to predict the three variables, with the areas under the curve （AUC） of 0. 763, 0. 633, and 0. 724,respectively. CONCLUSION The low TTP is the independent risk factor for severe sepsis and septic shock, catheter related infection, and poor prognosis, and the accuracies of TTP for predietinl~ the three variables are moderate, low, and moderate, respectively.

关 键 词：血培养 阳性报警时间 金黄色葡萄球菌 血流感染 临床特征 预后 

分 类 号：R378.11[医药卫生—病原生物学]