腹泻患者中细菌病原体的症状和 PCR 检测间隔。
Symptoms and PCR testing interval for bacterial pathogens in patients with diarrhoea.
机构信息
Department of Hepatology and Gastroenterology, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht, Netherlands.
Present address: Gelre Ziekenhuizen, Albert Schweitzerlaan 31, Apeldoorn, Netherlands.
出版信息
J Med Microbiol. 2022 Apr;71(4). doi: 10.1099/jmm.0.001541.
Acute diarrhoea can be caused by species, species, , species and (SSYCP). In clinical practice, however, polymerase chain reaction (PCR) for SSYCP is frequently performed as part of the diagnostic work-up for patients with chronic diarrhoea and gastrointestinal complaints. This study postulates that PCR for SSYCP is of limited clinical use in patients with chronic diarrhoea and gastrointestinal complaints. The primary aim of this study is to evaluate whether testing for SSYCP remains sensible in patients with chronic diarrhoea and gastrointestinal symptoms and if earlier testing leads to more positive PCR results. Between January 2017 and December 2018, data on PCR results, culture results, symptoms, symptom to testing interval (STI) and immune status were retrospectively collected from the medical records of patients with gastrointestinal symptoms for whom PCR results for SSYCP were available. The STIs of PCR-positive patients and PCR-negative patients were compared.. In total, 146 PCR-positive and 149 PCR-negative patients were included. STIs of <7 days occurred in 55 % of all PCR-positive patients compared to 38 % in PCR-negative patients. PCR-positive patients were more often tested within 7 days after onset of gastrointestinal symptoms or diarrhoea. A third of PCR-positive patients had an STI of >7 days. Immunocompromised patients had a shorter STI. Admitted patients had a shorter STI. Eighty-six PCR-positive patients had a positive culture (58 %). Antibiotic use 3 months prior to PCR testing was correlated with negative PCR results. This study shows that early testing correlates with more positive PCR results and underlines that PCR for SSYCP is of lesser importance in the diagnostic workup of chronic diarrhoea and/or gastrointestinal symptoms. The shorter STI found in immunocompromised patients is possibly due to a lower threshold for testing in this population. It is also important to take recent antibiotic use into consideration when interpreting PCR results, given the correlation between negative PCR results and antibiotic use. Careful and precise documentation of symptoms in medical records is essential for clinical practice and research.
急性腹泻可由 、 、 、 （SSYCP）引起。然而，在临床实践中，聚合酶链反应（PCR）常用于慢性腹泻和胃肠道疾病患者的诊断。本研究假设，对于慢性腹泻和胃肠道疾病患者，PCR 检测对 SSYCP 的临床应用有限。本研究的主要目的是评估在慢性腹泻和胃肠道症状患者中，检测 SSYCP 是否仍然合理，如果早期检测是否会导致更多阳性 PCR 结果。2017 年 1 月至 2018 年 12 月，我们对胃肠道症状患者的病历进行了回顾性分析，收集了 PCR 结果、培养结果、症状、检测间隔时间（STI）和免疫状况的数据，这些患者的 SSYCP PCR 结果可用。比较了 PCR 阳性患者和 PCR 阴性患者的 STI。共纳入 146 例 PCR 阳性患者和 149 例 PCR 阴性患者。所有 PCR 阳性患者中，STI 小于 7 天的发生率为 55%，而 PCR 阴性患者中为 38%。PCR 阳性患者在胃肠道症状或腹泻发作后 7 天内接受检测的比例更高。三分之一的 PCR 阳性患者的 STI 大于 7 天。免疫功能低下的患者 STI 较短。住院患者的 STI 较短。86 例 PCR 阳性患者培养阳性（58%）。PCR 检测前 3 个月使用抗生素与 PCR 结果阴性相关。本研究表明，早期检测与更多阳性 PCR 结果相关，并强调 PCR 检测对慢性腹泻和/或胃肠道症状的诊断意义不大。免疫功能低下患者的 STI 较短，可能是由于该人群检测阈值较低。在解释 PCR 结果时，还需要考虑近期抗生素使用情况，因为 PCR 结果阴性与抗生素使用有关。在医疗记录中仔细准确地记录症状对于临床实践和研究至关重要。
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