ICU患者血流感染特征及炎症因子的临床价值  

Characteristics in ICU patients with bloodstream infection and clinical value of inflammatory factors

作　　者：冯钧帅 王贤东[2] 傅彩虹[2] 周慧茹[2] 李德红[3] 李可可 魏莲花[3] FENG Junshuai;WANG Xiandong;FU Caihong;ZHOU Huiru;LI Dehong;Li Keke;WEI Lianhua(Department of Infectious Disease,Gansu Provincial Hospital,Lanzhou,Gansu 730000,China;Department of Intensive Medicine,Gansu Provincial Hospital,Lanzhou,Gansu 730000,China;Department of Clinical Laboratory,Gansu Provincial Hospital,Lanzhou,Gansu 730000,China)

机构地区：[1]甘肃省人民医院感染科,甘肃兰州730000 [2]甘肃省人民医院重症医学科,甘肃兰州730000 [3]甘肃省人民医院检验科,甘肃兰州730000

出　　处：《国际检验医学杂志》2020年第14期1670-1673,共4页International Journal of Laboratory Medicine

基　　金：甘肃省自然科学基金项目(17JR5RA035)。

摘　　要：目的探讨重症监护病房(ICU)血流感染患者的病原学特点及炎症因子的临床价值。方法回顾性分析2015年1月至2018年10月ICU血流感染患者65例,根据细菌鉴定结果分为革兰阴性菌组(43例)和革兰阳性菌组(22例),根据细菌药敏结果分为敏感菌组(21例)和耐药菌组(44例)。分别对各组炎症因子[血清降钙素原(PCT)、C反应蛋白(CRP)、白细胞介素-6(IL-6)、白细胞计数(WBC)]水平进行比较,对所有患者血培养阳性时和转阴后的炎症因子水平进行比较。结果ICU血流感染以耐药的革兰阴性菌为主。检测出的革兰阴性菌以大肠埃希菌、肺炎克雷伯菌及阴沟肠杆菌为主;革兰阳性菌以金黄色葡萄球菌、屎肠球菌及表皮葡萄球菌为主。血流感染主要来源于深静脉导管相关性感染、肺部感染及腹腔感染。革兰阴性菌组血清PCT水平明显高于革兰阳性菌组(P<0.05),两组IL-6、CRP、WBC水平比较,差异无统计学意义(P>0.05)。敏感菌组血清PCT、IL-6及CRP水平明显高于耐药菌组(P<0.05),两组WBC水平比较,差异无统计学意义(P>0.05)。所有患者血培养转阴后血清PCT、IL-6、CRP及WBC水平明显低于血培养阳性时的水平(P<0.05)。结论ICU血流感染以耐药的革兰阴性菌为主,血清PCT检测对鉴别革兰阴性菌和革兰阳性菌有一定作用,PCT、IL-6、CRP及WBC检测对判断耐药菌及血培养转阴有一定价值。Objective To investigate the characteristics of etiology of ICU patients with bloodstream infection and the clinical value of inflammatory factors.Methods Sixty-five ICU patients with bloodstream infection from January 2015 to October 2018 were retrospectively analyzed and divided into the Gram-negative bacterial group(43 cases)and Gram-positive bacterial group(22 cases)according to the results of bacterial identification,and the sensitive bacteria group(21 cases)and drug-resistant bacteria group(44 cases)according to the results of drug susceptibility test.The levels of inflammatory factors such as PCT,CRP,IL-6 and WBC were compared between the groups.The levels of the inflammatory factors in blood culture positive and blood culture negative conversion were compared among all cases.Results ICU bloodstream infection was dominated by drug-resistant Gram-negative bacteria.The detected Gram-negative bacteria were mainly Ecscherichia coli,Klebsiella pneumoniae and Enterobacter cloacae;Gram-positive bacteria were mainly Staphylococcus aureus,Enterococcus faecium and Staphylococcus.Bloodstream infection mainly originated from deep venous catheter related infection,pulmonary infection and intra-abdominal infection.The serum PCT level in the Gram-negative bacteria group was significantly higher than that in the Gram-positive group(P<0.05),there was no statistically significant difference in the levels of IL-6,CRP and WBC between the two groups(P>0.05).The levels of serum PCT,IL-6 and CRP in the sensitive bacteria group were significantly higher than those in the drug-resistant bacteria group(P<0.05).There was no statistically significant difference in the WBC level between the two groups(P>0.05).The levels of serum PCT,IL-6,CRP and WBC after blood culture negative conversion in all cases were significantly lower than those in blood culture positive(P<0.05).Conclusion The bloodstream infection in ICU is dominated by drug-resistant Gram-negative bacteria.Serum PCT detection has a certain effect on the identification of Gra

关 键 词：重症监护病房 血流感染 降钙素原 白细胞介素-6 C反应蛋白 

分 类 号：R446.11[医药卫生—诊断学]