Li Jing, Hu Lijuan, Li Lei
Department of Emergency, Shanxi Bethune Hospital, Taiyuan, China.
Emerg Med Int. 2022 Oct 8;2022:2498435. doi: 10.1155/2022/2498435. eCollection 2022.
The aim of the study is to analyze the clinical characteristics, pathogen distribution, and drug sensitivity information of adult sepsis, and to provide reference for empirical clinical use; to explore the relationship between -reactive protein (CRP) and calcitonin (PCT) The clinical value in the diagnosis of adult sepsis.
We collected 455 cases of hospitalized patients with positive blood culture, including 352 cases with sepsis and 103 cases without sepsis; 1609 cases of hospitalized patients with suspected infection and negative blood culture, including 287 cases of sepsis, and 518 cases of non-infectious systemic inflammatory response syndrome (SIRS) and 804 cases of local infection. Age, gender, route of admission, admission status, CRP, PCT, and white blood cell (WBC) levels were collected from the patients. The differences between the factors were statistically analyzed, and the receiver operating characteristic curve (ROC curve) was plotted to obtain the optimal cut-off values of CRP and PCT and their area under the curve (AUC), and to compare the CRP, PCT and PCT, and the CRP + PCT tandem to diagnose sepsis sensitivity and specificity.
(1) 387 pathogenic strains were isolated from blood cultures of patients with sepsis, 71.06% Gram-negative, 26.87% Gram-positive and 2.07% fungi. (2) Among Gram-positive bacteria, was 87.5% resistant to penicillin and sensitive to vancomycin, milantropine, and teicoplanin; among Gram-negative bacteria, was resistant to piracillin The resistance rate was 73.1%, fully susceptible to viraemia (100%) and resistant to imipenem, amikacin, and lacillin/tazole. (3) Among patients with positive blood cultures, CRP and PCT levels were higher in patients with sepsis than in those without sepsis. Pairwise comparison of ROC curves showed that the diagnostic value of PCT was greater than that of CRP (=0.016).
CRP and PCT have a good reference value for diagnosis of sepsis patients and determination of the degree of infection in septic patients, especially PCT is more valuable for diagnosis of sepsis.
分析成人脓毒症的临床特征、病原菌分布及药敏情况,为临床经验用药提供参考;探讨C反应蛋白(CRP)和降钙素原(PCT)在成人脓毒症诊断中的临床价值。
收集455例血培养阳性住院患者,其中脓毒症患者352例,非脓毒症患者103例;1609例疑似感染血培养阴性住院患者,其中脓毒症患者287例,非感染性全身炎症反应综合征(SIRS)患者518例,局部感染患者804例。收集患者的年龄、性别、入院途径、入院状态、CRP、PCT及白细胞(WBC)水平。对各因素间差异进行统计学分析,绘制受试者工作特征曲线(ROC曲线),得出CRP和PCT的最佳截断值及其曲线下面积(AUC),比较CRP、PCT及CRP+PCT串联诊断脓毒症的敏感性和特异性。
(1)从脓毒症患者血培养中分离出387株病原菌,革兰阴性菌占71.06%,革兰阳性菌占26.87%,真菌占2.07%。(2)革兰阳性菌中, 对青霉素耐药率为87.5%,对万古霉素、米诺环素和替考拉宁敏感;革兰阴性菌中,对哌拉西林耐药率为73.1% ,对维罗培南完全敏感(100%),对亚胺培南、阿米卡星和哌拉西林/他唑巴坦耐药。(3)血培养阳性患者中,脓毒症患者的CRP和PCT水平高于非脓毒症患者。ROC曲线两两比较显示,PCT的诊断价值大于CRP(=0.016)。
CRP和PCT对脓毒症患者的诊断及判断脓毒症患者感染程度有较好的参考价值,尤其是PCT对脓毒症的诊断更有价值。