Daef Enas A, Elsherbiny Nahla M, Agban Michael N, Riad Khalid F, Mohammed Lamia F
Department of Medical Microbiology & Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
Department of Pediatric Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
Egypt J Immunol. 2018 Jun;25(2):21-34.
The diagnosis of blood steam infections (BSIs) in febrile neutropenic pediatric cancer patients (FNPCP) remains a challenge. Although blood culture is the most accurate method; yet the delay in results has urged the need for reliable biomarkers for early diagnosis. The objectives of this study were to identify the bacterial causes of BSIs in FNPCP at SECI and their antimicrobial susceptibility patterns. Also, to assess the value of procalcitonin (PCT), interleukin 6 (IL6), and interleukin 10 (IL 10) for early diagnosis of BSIs. This study included 68 FNPCP with a total of 85 fever episodes. Blood cultures were done at the onset of fever. Identification of the organisms was carried by Vitek 2 system and the antimicrobial susceptibility testing by disc diffusion. The levels of PCT, IL-6 and IL-10 serum levels were measured by ELISA. Blood stream bacterial infection was detected in 29.4% (25/85). Most were Gram positive cocci in 53.6 % (15/28). There were high percentages of multidrug resistant organism (MDRO) (73.3% and 92.3% among Gram positive and negative bacteria, respectively). The least percentage of resistance was to linezolid (0%) and amikacin (15.4%). The levels of the biomarkers were significantly higher in patients with positive bacterial cultures compared to those with negative cultures (P < 0.001). IL -6 had the best sensitivity (96%) (AUC 0.975, cut off 0.925ng/L) with considerable specificity (88.3%). Combined PCT & IL-6 had the highest sensitivity (96%) and specificity (98.3%). We conclude that the percentage of BSIs among FNPCP was considerable. Gram positive bacteria were the commonest causes. High percentages of MDRO were reported. The most efficient antimicrobials were linezolid and amikacin. IL-6 alone had the best sensitivity for early diagnosis of BSIs. The combination of PCT and IL 6 showed the best performance.
发热性中性粒细胞减少的儿科癌症患者（FNPCP）的血流感染（BSIs）诊断仍然是一项挑战。尽管血培养是最准确的方法，但结果延迟促使人们需要可靠的生物标志物用于早期诊断。本研究的目的是确定SECI的FNPCP中BSIs的细菌病因及其抗菌药物敏感性模式。此外，评估降钙素原（PCT）、白细胞介素6（IL6）和白细胞介素10（IL 10）对BSIs早期诊断的价值。本研究纳入了68例FNPCP，共85次发热发作。在发热开始时进行血培养。通过Vitek 2系统鉴定微生物，采用纸片扩散法进行抗菌药物敏感性测试。通过ELISA测定PCT、IL-6和IL-10血清水平。29.4%（25/85）检测到血流细菌感染。大多数是革兰氏阳性球菌，占53.6%（15/28）。多重耐药菌（MDRO）的比例很高（革兰氏阳性菌和阴性菌中分别为73.3%和92.3%）。耐药比例最低的是利奈唑胺（0%）和阿米卡星（15.4%）。与阴性培养患者相比，细菌培养阳性患者的生物标志物水平显著更高（P < 0.001）。IL -6具有最佳敏感性（96%）（AUC 0.975，临界值0.925ng/L），特异性相当高（88.3%）。PCT与IL-6联合使用具有最高敏感性（96%）和特异性（98.3%）。我们得出结论，FNPCP中BSIs的比例相当可观。革兰氏阳性菌是最常见的病因。报告了高比例的MDRO。最有效的抗菌药物是利奈唑胺和阿米卡星。单独使用IL-6对BSIs早期诊断具有最佳敏感性。PCT和IL 6联合使用表现最佳。
