血培养阳性报警时间在大肠埃希菌血流感染患者预后评估中的应用价值研究  

Time to Positivity of Blood Culture:Application Value in Prognosis Evaluation in Patients with Bloodstream Infection Caused by Escherichia Coli

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,北京市100034

出　　处：《中国全科医学》2014年第2期162-165,共4页Chinese General Practice

基　　金：国家科技支撑计划(2012BAH24F01)

摘　　要：目的评估血培养阳性报警时间(TTP)对大肠埃希菌血流感染患者发生严重脓毒血症及脓毒血症休克、住院期间死亡的预测价值。方法选择2008—2012年在我院行血培养分离到大肠埃希菌且病历资料完整的成年住院患者174例,以TTP的P25(7.13 h)为切点,将患者分为低TTP组43例和高TTP组131例,比较两组患者临床特征及预后情况。结果两组患者中高龄(≥65岁)比例、男性比例、院内获得性感染发生率、基础状态差比例、菌株产超广谱β内酰胺酶(ESBL)率、原发感染灶、感染相关危险因素比较,差异均无统计学意义(P>0.05);低TTP组严重脓毒血症及脓毒血症休克发生率、住院期间病死率均高于高TTP组(P<0.05)。Logistic回归分析结果显示,低TTP预测患者发生严重脓毒血症及脓毒血症休克的OR为6.618〔95%CI(3.036,14.429),P<0.001〕,预测患者住院期间死亡的OR为4.159〔95%CI(1.623,0.657),P=0.003〕。绘制ROC曲线发现,TTP≤9.72 h为预测患者发生严重脓毒血症及脓毒血症休克的最佳切点〔曲线下面积(AUC)=0.792〕,TTP≤9.38 h为预测患者住院期间死亡的最佳切点(AUC=0.708)。结论低TTP对大肠埃希菌血流感染患者发生严重脓毒血症及脓毒血症休克、住院期间死亡的预测价值为中等,可为临床不易察觉的早期菌血症提供重要预警信息。Objective To investigate the prognostic value of time to positivity （YFP） of blood culture in patients with bloodstream infection （BSI） caused by Escherichia coli （E. coli）. Methods A total of 174 adult inpatients, who had blood culture and from whom E. eoli were isolated from 2008 to 2012, were divided, taking P25 （7.13 h） of TIP as cutoff point, into groups low- TIP （n =43） , high -TIP （n = 131 ）. The clinical features, prognoses were compared between 2 groups. Re- suits There was no significant difference in proportion of elderly patients, that of males, incidence of hospital - acquired infec- tion, proportion of poor basic state, rate of strain - produced extended - spectrum β - lactamase （ESBL） , primary infection lo- ci, infection associated risk factors between 2 groups （ P 〉 0. 05 ）. The incidences of severe sepsis and septic shock, mortality rate were higher in low - TTP group than in high - TIP group （ P 〈 0. 05 ）. Logistic regression analysis showed that OR of low - TTP predicting occurrence of severe sepsis and septic shock was 6. 618 [ 95% CI （3. 036, 14. 429 ）, P 〈 0. 001 ], and that predicting hospital death was 4. 159 [ 95% CI （ 1. 623, 0. 657 ）, P = 0. 003 ]. ROC curves showed that TIP ≤9. 72 h was the best cut - off point predicting occurrence of severe sepsis and septic shock （AUC =0. 792）, and that TTP≤9.38 h was the best cut - off point predicting hospital death （AUC = 0. 708 ）. Conclusion The value of low TIP predicting occurrence of severe sepsis and septic shock, hospital death is medium in BSI patients caused by E. coli, which provides important warning informa- tion of early bacteremia uneasy to be detected clinically.

关 键 词：阳性报警时间 大肠埃希菌感染 疾病特征 预后 

分 类 号：R378.21[医药卫生—病原生物学] R631[医药卫生—基础医学]