血培养报阳时间对肿瘤患者并发大肠埃希菌血流感染产AmpC酶及死亡的预测价值  

Time to positivity of blood culture as a predictor of AmpC-β-lactamase and mortality in tumor patients with E.coli bloodstream infection

作　　者：张青 李丁 李峥 白长森 张文芳 郑珊 周云丽 ZHANG Qing;LI Ding;LI Zheng;BAI Changsen;ZHANG Wenfang;ZHENG Shan;ZHOU Yunli(Tianjin Medical University Cancer Institute and Hospital,Tianjin 300060,China)

机构地区：[1]天津医科大学肿瘤医院,国家肿瘤临床医学研究中心,天津市肿瘤防治重点实验室,天津市恶性肿瘤临床医学研究中心,天津300060

出　　处：《山东医药》2020年第17期13-16,共4页Shandong Medical Journal

基　　金：国家自然科学基金项目(81802080)。

摘　　要：目的探讨血培养报阳时间(TTP)对肿瘤患者并发大肠埃希菌血流感染产AmpC酶及住院期间死亡的预测价值。方法收集大肠埃希菌血流感染的成人肿瘤患者248例,取外周静脉无菌穿刺血液并记录血培养TTP,用改良三维试验检测大肠埃希菌产AmpC酶情况。采用单因素、多变量回归分析影响患者住院期间死亡的相关因素,绘制受试者工作特征(ROC)曲线分析TTP预测大肠埃希菌产AmpC酶及患者死亡的价值。结果血培养TTP为(9.42±3.45)h,产AmpC菌株45株(18.1%)。产AmpC酶患者TTP为(7.97±1.960)h,短于非产AmpC酶患者的(9.75±3.56)h(P<0.001);ROC曲线显示,血培养TTP预测大肠埃希菌产AmpC酶的最佳截点为8.16 h,此时的敏感度为72%、特异度为62%、曲线下面积(AUC)为0.680。单因素分析显示,血培养TTP、肿瘤转移、器官衰竭、脓毒症、休克、机械通气和输血是患者住院期间死亡的预测风险因子(P均<0.05);多变量回归分析显示,TTP(OR=2.29,95%CI 0.69~8.63,P=0.042)是患者住院期间死亡的独立危险因素。ROC曲线显示,血培养TTP预测肿瘤并发大肠埃希菌血流感染患者住院期间死亡的最佳截点为9.24 h,此时的敏感度为66%、特异度为75%、AUC为0.692。结论血培养TTP既可以作为大肠埃希菌产AmpC酶的预测指标,又是大肠埃希菌血流感染肿瘤患者死亡的预测风险因子;临床医生可依据血培养TTP的长短并结合实验室其他指标,及早选择合适抗生素治疗以提高肿瘤患者生存率。Objective To explore time to positivity(TTP)of blood culture as a predictor of AmpCβ-lactamase and the in-hospital mortality in tumor patients with Escherichia coli bloodstream infection(BSI).Methods The positive blood culture data of 248 adult tumor patients with Escherichia coli BSI were collected.TTP was recorded by peripheral vein aseptic puncture,and the production of AmpC-β-lactamase was detected by modified three-dimensional test.The area under receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of TTP for the production of AmpC-β-lactamase and the mortality of patients.Results TTP was(9.42±3.45)h,and 45 strains(18.1%)produced AmpC.TTP was(7.97±1.96)h in the enzyme producing group,which was shorter than that in the non-AmpC enzyme-producing group(9.75±3.56)h(P<0.001).ROC curve showed that the best cut-off value of TTP for predicting AmpC-β-lactamase was 8.16 h,and the sensitivity,specificity,and AUC were 72%,62%and 0.680,respectively.Univariate analysis showed that TTP,metastasis,organ failure,sepsis,shock,mechanical ventilation,and blood transfusion were predictive risk factors for in-hospital mortality(all P<0.05);multivariate regression analysis showed that TTP(OR=2.29,95%CI 0.69-8.63,P=0.042)was the independent predictive risk factor for in-hospital mortality.ROC curve showed that the best cut-off value for TTP to predict the in-hospital mortality of tumor patients with Escherichia coli BSI was 9.24 h,with the sensitivity of 66%,specificity of 75%,and AUC of 0.692.Conclusions Short TTP of blood culture can be used as a predictor of AmpCβ-lactamase,and also as a predictive risk factor for mortality in tumor patients with Escherichia coli BSI.According to the length of TTP of blood cultrue and other clinical variables,clinicians can select the appropriate antibiotic treatment as early as possible to improve the survival of tumor patients.

关 键 词：血培养报阳时间 大肠埃希菌 AMPC酶 血流感染 预后 

分 类 号：R446.5[医药卫生—诊断学]