多重耐药菌快速检测对改善严重腹腔感染预后的临床价值  

Effects of rapid drug sensitivity testing for multidrug-resistant bacteria on the prognosis of patients with severe intra-abdominal infection

作　　者：王家杰 李家扬 吴文琦 邱明杰 武存霞 周志涛 吴美琳 田赛 吴磊[1,3] 张锦鹏 张哲瑞 田芮瑕 洪之武 任华建 王革非 吴秀文 任建安 Wang Jiajie;Li Jiayang;Wu Wenqi;Qiu Mingjie;Wu Cunxia;Zhou Zhitao;Wu Meilin;Tian Sai;Wu Lei;Zhang Jinpeng;Zhang Zherui;Tian Ruixia;Hong Zhiwu;Ren Huajian;Wang Gefei;Wu Xiuwen;Ren Jian'an(Research Institute of General Surgery,Jinling Hospital,the Affiliated Second Clinical Hospital,Medical School of Southeast University,Nanjing 210002,China;Department of Clinical Medicine,Medical School of Nanjing University,Nanjing 210093,China;Department of Clinical Medicine,Jinling Hospital,Nanjing Medical University,Nanjing 211166,China;Department of Pharmacy,Nanjing University of Chinese Medicine,Nanjing 210023,China)

机构地区：[1]东南大学医学院附属第二临床医院(东部战区总医院)全军普通外科研究所,南京210002 [2]南京大学医学院临床医学系,南京210093 [3]南京医科大学金陵临床医学院临床医学系,南京211166 [4]南京中医药大学药学系,南京210023

出　　处：《中华胃肠外科杂志》2023年第9期847-852,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：江苏省重点研发计划(BE2022823);江苏省医学创新中心(CXZX202217);临床研究专项领航项目(22LCYY-LH4)。

摘　　要：目的探究耐药菌快速检测的临床应用对并发碳青霉烯耐药肠杆菌科细菌(CRE)血流感染的严重腹腔感染患者预后改善的价值。方法采用回顾性队列研究方法。收集东部战区总医院普通外科2022年2月至2023年2月期间收治的73例伴脓毒症或脓毒性休克、并发CRE血流感染的严重腹腔感染患者的临床资料。依据诊疗过程中,是否针对首个CRE阳性血培养样本进行胶体金免疫层析法(GICA)检测,将患者分为GICA组(17例)和常规检测组(56例)。GICA组和常规检测组的年龄[分别为(55.9±17.3)岁和(47.6±16.4)岁]、性别(分别为16例男性、1例女性和41例男性、15例女性)、Charlson合并症指数中位数[分别为3.0(2.0,4.0)和3.0(2.0,4.8)]、脓毒性休克(分别为10例和39例)和急性肾损伤(分别为8例和40例)等一般资料差异均无统计学意义(均P>0.05)。两组患者的血培养标本均常规进行传统细菌鉴定及药物敏感检测;GICA组患者使用GICA试剂盒直接检测阳性血培养标本,进行碳青霉烯酶检测。主要观察指标为两组患者自CRE血流感染发作到启用针对性抗生素及合理抗生素的时间以及首次CRE血流感染后28 d和90 d病死率。次要观察指标包括微生物清除率、住院时长和重症监护室(ICU)住院时长。结果GICA组患者血流感染微生物清除率相较于常规检测组升高,差异有统计学意义[15/17比60.7%(34/56),χ^(2)=4.476,P=0.034];28 d病死率[5/17比44.6%(25/56),χ^(2)=1.250,P=0.264]、90 d病死率[8/17比53.6%(30/56),χ^(2)=0.222,P=0.638]、中位住院时长[37.0(18.0,46.5)d比45.5(32.2,64.8)d,Z=-1.867,P=0.062]以及中位ICU住院时长[18.0(6.5,35.0)d比32.0(5.0,51.8)d,Z=-1.251,P=0.209]均有下降趋势,但差异尚无统计学意义。GICA组自血流感染发作到启用针对性抗生素的中位时间为49.0(38.0,69.0)h,短于常规检测组的163.0(111.8,190.0)h,差异有统计学意义(Z=-5.731,P<0.001);启用合理抗生素的中位时间为40.0(38.0,80.Objective To examine the clinical value of rapid detection of drug-resistant bacteria by immunochromatography and the effects of rapid detection on the prognosis of patients with severe intra-abdominal infection complicated by carbapenem-resistant Enterobacteriaceae(CRE)bloodstream infection.Methods This was a retrospective cohort study.We analyzed clinical data of 73 patients with severe abdominal infections with sepsis or septic shock complicated by CRE bloodstream infection admitted to the general surgery department of Jinling Hospital between February 2022 and February 2023.Patients were divided into a colloidal gold immunochromatographic assay(GICA)group(17 patients)and conventional testing group(56 patients)based on whether a GICA for CRE had been performed on the patients'first blood culture sample during the diagnosis and treatment process.There were no statistically significant differences between the GICA and conventional testing groups in age([55.9±17.3]vs.[47.6±16.4]years),sex([16 men vs.one woman]vs.[41 men vs.15 women]),median Charlson comorbidity index(3.0[2.0,4.0]vs.3.0[2.0,4.8]),septic shock(10 vs.39),or acute kidney injury(8 vs.40)(all P>0.05).Both groups routinely underwent traditional bacterial identification and drug susceptibility testing.Additionally,patients in the GICA group were tested directly for positive blood cultures using a GICA carbapenemase test kit.The main outcomes were mortality rates on Days 28 and 90 after the first identification of CRE bloodstream infection in both groups.We also compared the microbial clearance rate,duration of hospitalization and intensive care unit stay,and time from onset of CRE bloodstream infection to initiation of targeted and appropriate antibiotics between the two groups.Results The rate of microbial clearance of bloodstream infection was significantly greater in the GICA group than in the conventional testing group(15/17 vs.34/56[60.7%],χ^(2)=4.476,P=0.034),whereas the 28-day mortality tended to be lower in the GICA than conventional testing g

关 键 词：严重腹腔感染 胶体金免疫层析法 多重耐药 碳青霉烯酶 碳青霉烯耐药肠杆菌科细菌 

分 类 号：R446.5[医药卫生—诊断学] R656[医药卫生—临床医学]