qPCR快速检测ICU下呼吸道感染患者鲍曼不动杆菌的临床价值  

Clinical value of rapid detection of Acinetobacter baumannii in ICU patients with lower respiratory tract infection by qPCR

作　　者：魏晶晶 张铮[1] 沈华[1] 秦海东[1] 孙才智[1] 季伟[1] 宋杨[1] 郭磊[1] WEI Jing-jing;ZHANG Zheng;SHEN Hua;QIN Hai-dong;SUN Cai-zhi;Ji Wei;SONG Yang;GUO Lei(Department of Emergency,Nanjing first Hospital,Nanjing Medical University,Nanjing 210000,Jiangsu,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)急诊科,南京210000

出　　处：《医学研究生学报》2022年第11期1176-1179,共4页Journal of Medical Postgraduates

基　　金：南京市卫生科技发展项目(YKK20114)。

摘　　要：目的目前临床上尚缺乏一种准确、高效检测鲍曼不动杆菌(AB)的临床手段。文中探讨实时荧光定量聚合酶链反应(qPCR)快速检测重症监护室(ICU)下呼吸道感染患者痰标本中AB的临床价值。方法回顾性分析2018年1月至2020年12月南京市第一医院ICU痰培养结果为AB患者临床资料及耐药情况。以痰培养结果为参照,分析qPCR的灵敏度、特异度、阳性和阴性预测值,计算ROC曲线下面积以评价诊断效能。结果本研究共获得376株AB,对头孢他啶等3种抗菌药物的耐药率均≥80%,对环丙沙星、亚胺培南等4种抗菌药物的耐药率均接近80%;而对多粘菌素B的敏感率高达87.5%,对替加环素及复方新诺明的敏感率也均超过50%。qPCR检测痰标本AB的阳性率明显高于痰培养(15.90%vs 7.67%,P=0.000)。以痰培养结果作为对照,qPCR检测的灵敏度为88.06%,特异度为90.09%,阳性预测值为42.45%,阴性预测值达到98.91%,ROC曲线下面积为0.795。结论qPCR可快速检测ICU下呼吸道感染患者的AB,及时调整用药有助于改善预后。Objective To explore the clinical value of quantitative real-time polymerase chain reaction(qPCR)for rapid detection of Acinetobacter baumannii(AB)in sputum samples of patients with lower respiratory tract infection in ICU.Methods(1)The results of sputum culture in ICU of Nanjing Hospital Affiliated to Nanjing Medical University from January 2018 to December 2020 were analyzed retrospectively.(2)Sputum samples in ICU from June 2019 to March 2020 were selected for sputum culture and qPCR.The sensitivity,specificity,positive and negative predictive values,and area under the ROC curve of qPCR rapid detection were compared with the results of sputum culture.Results(1)A total of 376 strains of AB were obtained from sputum samples of lower respiratory tract infection in ICU of our hospital from January 2018 to December 2020,and their drug resistance rates to ceftazidime and other 3 antibacterial drugs were all≥80%,and the drug resistance rates to ciprofloxacin and imipenem and other 4 antibacterial drugs were all close to 80%.The sensitivity rate to polymyxin B was 87.5%,and the sensitivity rates to tigacycline and cotrimoxazole were also more than 50%.(2)The positive rate of AB in sputum samples detected by qPCR was significantly higher than that in sputum culture,and the difference was statistically significant(15.90%vs 7.67%,P=0.000).With the sputum culture results as the control,the sensitivity of qPCR detection was 88.06%,the specificity was 90.09%,the positive predictive value was 42.45%,the negative predictive value was 98.91%,and the area under the ROC curve was 0.795.Conclusion The qPCR detection method can be used to quickly detect AB in sputum samples of patients with lower respiratory tract infection in ICU,and the immediate medicine adjustment is helpful to improve the clinical prognosis.

关 键 词：鲍曼不动杆菌 耐药 实时荧光定量聚合酶链式反应 细菌培养 下呼吸道感染 重症监护室 

分 类 号：R711.75[医药卫生—妇产科学]