Stubljar David, Skvarc Miha
Faculty of Medicine, Institute of Microbiology and Immunology, Zaloska 4, Ljubljana, Slovenia,
Folia Microbiol (Praha). 2015 Mar;60(2):111-8. doi: 10.1007/s12223-014-0346-y. Epub 2014 Sep 26.
The aging population and increased incidence of severe bacterial infection can lead to sepsis. Interest to early identification of endangered patients and identification of pathogen do not always confirm the infection. To use biomarkers can help in early identification of infection and opportunity to start therapy timeously. All biomarkers were defined in 33 out of 96 patients. Thirty-two (97 %) patients had bacterial infection and 1 (3 %) patient had systemic inflammatory response syndrome (SIRS) without infection. PCR confirmed the infection in 27 cases and blood cultures in 8. Area under curve (AUC) for CD64 was 1.00, meanwhile other biomarkers showed 2-fold smaller AUC for positive infection. CD64 index was associated with bacterial infection (p<0.001) and could be used to confirm assessment of SIRS severity (p=0.037). As regards to our results, limited to only 33 patients, CD64 index served as a good parameter to predict bacterial infection and determine severity. The use of broad range 16S ribosomal RNA (rRNA) PCR proved to be an excellent tool to confirm bloodstream infection. The CD64 index had the highest AUC, which exceeded all the others, and could be used to predict the outcome of broad range 16S rRNA PCR from whole blood. However, C-reactive protein (CRP), procalcitonin (PCT) and sCD14 are much easier and faster to measure, but the values could be elevated in other clinical assessments.
人口老龄化以及严重细菌感染发病率的上升会导致脓毒症。对濒危患者进行早期识别以及对病原体进行鉴定的相关研究并不总能确诊感染情况。使用生物标志物有助于早期识别感染，并及时开始治疗。在96例患者中，有33例测定了所有生物标志物。32例（97%）患者发生细菌感染，1例（3%）患者出现无感染的全身炎症反应综合征（SIRS）。PCR确诊27例感染，血培养确诊8例。CD64的曲线下面积（AUC）为1.00，而其他生物标志物对阳性感染的AUC小2倍。CD64指数与细菌感染相关（p<0.001），可用于确认SIRS严重程度的评估（p=0.037）。就我们仅涉及33例患者的研究结果而言，CD64指数是预测细菌感染和确定严重程度的良好参数。使用广谱16S核糖体RNA（rRNA）PCR被证明是确认血流感染的极佳工具。CD64指数的AUC最高，超过了所有其他指标，可用于预测全血中广谱16S rRNA PCR的结果。然而，C反应蛋白（CRP）、降钙素原（PCT）和可溶性CD14的检测要容易得多且速度更快，但在其他临床评估中这些值可能会升高。
