血培养阳性报警时间在葡萄球菌菌血症中的临床诊断效能评价  

Efficiency of time to positivity for blood culture in clinical diagnosis of Staphylococci bacteremia

作　　者：崔博沛 叶丽艳[1] 马薇[1] 沈跃云[1] 赵乾 罗燕萍[1] CUI Bo-pei;YE Li-yan;MA Wei;SHEN Yue-yun;ZHAO Qian;LUO Yan-ping(General Hospital of the People＇s Liberation Army,Beijing 100853,China)

机构地区：[1]解放军总医院微生物科,北京100853 [2]中国食品药品检定研究院肝炎病毒疫苗室,北京100050

出　　处：《中华医院感染学杂志》2018年第17期2567-2571,共5页Chinese Journal of Nosocomiology

基　　金：军队"十二五"重大基金资助项目(AWS11C001)

摘　　要：目的探讨血培养阳性报警时间(TTP)在凝固酶阴性葡萄球菌(CoNS)和金黄色葡萄球菌(SA)所致血流感染中的应用价值。方法采用回顾性研究方法,收集解放军总医院2014年1月-2016年12月临床各科病房送检的血培养结果为葡萄球菌属阳性的患者临床资料和TTP。将所收集病例依据临床体征、检验结果等特征分为SA组、CoNS污染组、CoNS感染组,其中SA组依据耐药特征又分为甲氧西林耐药组(MRSA组)和甲氧西林敏感组(MSSA组),分析TTP对不同组病例鉴别诊断的价值。结果共收集葡萄球菌属阳性患者临床资料921份,其中CoNS污染组(n=596)、CoNS感染组(n=259),MSSA组(n=36)和MRSA组(n=30)。TTP在CoNS污染组、CoNS感染组、MSSA组与MRSA组之间有统计学差异(P<0.05);ROC曲线表明TTP cut-off值为20.95h时预测CoNS感染和CoNS污染的灵敏度为0.93,特异性为0.90;15.55h预测SA感染和CoNS感染的灵敏度为0.70,特异性为0.82;14.70h预测MRSA和MSSA的灵敏度为0.80,特异性为0.92。结论 TTP对于早期判断葡萄球菌属菌血症的存在与否以及指导临床用药具有一定的参考价值。OBJECTIVE To explore the value of time to positivity（TTP）for blood culture in diagnosis of bloodstream infection induced by coagulase-negative Staphylococcus and Staphylococcus aureus.METHODS By means of retrospective survey,the clinical data and TTP were collected from the patients who were positive for blood culture of Staphylococci in General Hospital of the People′s Liberation Army from Jan 2014 to Dec 2016,the enrolled cases were divided into the SA group,the CoNS contamination group and the CoNS infection group according to clinical signs and results of laboratory test,the cases of the SA group were divided into the MRSA group and the MSSA group according to characteristics of drug resistance,and the value of TTP in differential diagnosis was analyzed.RESULTS Of totally 921 patients who were cultured positive for Staphylococci,596 were in the CoNS group,259 in the CoNS infection group,36 in the MSSA group,30 in the MRSA group.There was significant difference in the TTP among the CoNS contamination group,the CoNS infection group,the MSSA group and the MRSA group（P〈0.05）.ROC curve indicated that when the cut-off value was 20.95 h,the sensitivity and specificity of TTP in prediction of CoNS infection and CoNS contamination were 0.93 and 0.90,respectively,the sensitivity and specificity of TTP in prediction of S.aureus infection were respectively 0.70 and 0.82 when the cut-off value was 15.55 h,and the sensitivity and specificity of TTP in prediction of MRSA and MSSA infection were respectively 0.80 and 0.92 when the cut-off value was 14.70 h.CONCLUSIONTTP has certain reference value in early diagnosis of Staphylococci bacteremia and guidance of clinical use of antibiotics.

关 键 词：血培养 阳性报警时间 葡萄球菌 受试者工作特征曲线 

分 类 号：R446.5[医药卫生—诊断学]