降钙素原在菌血症患者病因预测中的作用：来自一项大型单中心经验的报告。

Role of procalcitonin in predicting etiology in bacteremic patients: Report from a large single-center experience.

机构信息

Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy.

出版信息

J Infect Public Health. 2020 Jan;13(1):40-45. doi: 10.1016/j.jiph.2019.06.003. Epub 2019 Jun 24.

DOI:10.1016/j.jiph.2019.06.003

PMID:31248812

Abstract

BACKGROUND

Procalcitonin (PCT) is routinely used for an early recognition of severe infections and for promoting appropriate use of antibiotics. However, limited data correlating values of PCT with etiology of infection has been reported.

METHODS

During 2016, all positive blood cultures (BC) were retrospectively extracted in a 1100-beds Italian tertiary-care hospital. PCT and C-reactive protein (CRP) values were recorded within 24h from BC collection. Primary endpoint of the study was to investigate the correlation between PCT and CRP values and the occurrence of bloodstream infections (BSI) caused by bacteria or fungi.

RESULTS

During the study period, 1296 positive BC were included: 712 (54.9%) due to Gram-positive (GP), 525 (40.5%) due to Gram-negative (GN) strains, and 59 (4.6%) caused by fungi. Among GN isolates, enterobacteriaceae were reported in 453 (86.3%) cases. PCT values were higher in patients with GN etiology (26.1±14.2ng/mL) compared to GP (6.9±4.5) and fungi (3.3±2.4). Mean values for CRP in GN, GP, and fungi were not different. Receiver Operating Characteristic (ROC) curves showed an area under curve (AUC) of 0.71 for PCT and 0.51 for CRP among GN isolates; an AUC of 0.7 for PCT and 0.52 for CRP among enterobacteriaceae. Lower AUC for PCT were reported for GP and fungi.

CONCLUSIONS

PCT showed moderate performance in early detection (within 24h) of Gram-negative infections, especially those caused by enterobacteriaceae. Further prospective studies are mandatory to confirm these observations.

摘要

背景

降钙素原 (PCT) 常用于早期识别严重感染，并促进抗生素的合理使用。然而，目前关于 PCT 值与感染病因之间相关性的数据有限。

方法

在 2016 年，我们回顾性地从一家拥有 1100 张病床的意大利三级保健医院提取所有阳性血培养（BC）结果。在采集 BC 的 24 小时内，记录 PCT 和 C 反应蛋白（CRP）的值。本研究的主要终点是研究 PCT 和 CRP 值与由细菌或真菌引起的血流感染（BSI）之间的相关性。

结果

在研究期间，共纳入 1296 例阳性 BC：712 例（54.9%）为革兰阳性菌（GP），525 例（40.5%）为革兰阴性菌（GN），59 例（4.6%）为真菌。在 GN 分离株中，报告了 453 例（86.3%）肠杆菌科细菌。GN 病因患者的 PCT 值高于 GP（6.9±4.5ng/mL）和真菌（3.3±2.4ng/mL）（26.1±14.2ng/mL）。GN、GP 和真菌的 CRP 平均值无差异。ROC 曲线显示，在 GN 分离株中，PCT 的 AUC 为 0.71，CRP 的 AUC 为 0.51；在肠杆菌科细菌中，PCT 的 AUC 为 0.7，CRP 的 AUC 为 0.52。在 GP 和真菌中，PCT 的 AUC 较低。