An Rongcheng, Ou Yingwei, Pang Lingxiao, Yuan Yongsheng, Li Qian, Xu Hao, Sheng Bin
Emergency and Critical Care Center, Department of Emergency Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, People's Republic of China.
Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China.
Infect Drug Resist. 2023 Mar 18;16:1579-1590. doi: 10.2147/IDR.S400108. eCollection 2023.
Community-associated bloodstream infection (CA-BSI) is increasing in many community settings. However, the clinical significance and epidemiology of CA-BSI present in hospital admissions in China are not well established. In this work, we identified the risk factors in outpatients presenting with CA-BSI, and investigate the role of procalcitonin (PCT) and hypersensitive C-reactive protein (CRP) in diagnosing different types of the pathogen in patients with acute CA-BSI.
A retrospective study enrolling 219 outpatients with CA-BSI from The Zhejiang People's Hospital from January 2017 to December 2020 was performed. Susceptibility of the isolates obtained from these patients was examined. Subjecting receiver operating characteristic curves (ROC) were constructed to analyze the specificity and sensitivity of PCT, CRP, and WBC in determining infections caused by different bacterial genera. Risk factors for CA-BSI in the emergency setting were analyzed using essential information and simple identification of other pathogenic bacterial species through rapidly tested biomarkers.
A total of 219 patients were included in the selection criteria, of which 103 were infected with Gram-positive bacteria (G+) and 116 with Gram-negative bacteria (G-). The PCT was significantly higher in the GN-BSI group than in the GP-BSI group, while no significant difference was observed between the two groups for CRP. Subjecting ROC curves were constructed to analyze WBC, CRP, and PCT, and the area under the curve (AUC) of the PCT in this model was 0.6661, with sensitivity = 0.798 and specificity = 0.489.
The PCT between the GP-BSI group and the GN-BSI group was significantly different. By combining the knowledge of clinicians and the clinical signs of patients, PCT should be utilized as a supplementary approach to initially determine pathogens and direct medication in the early stages of clinical practice.
社区获得性血流感染（CA-BSI）在许多社区环境中呈上升趋势。然而，中国医院入院患者中CA-BSI的临床意义和流行病学尚不清楚。在本研究中，我们确定了门诊CA-BSI患者的危险因素，并探讨降钙素原（PCT）和超敏C反应蛋白（CRP）在诊断急性CA-BSI患者不同病原体类型中的作用。
对2017年1月至2020年12月浙江省人民医院收治的219例门诊CA-BSI患者进行回顾性研究。检测从这些患者中分离出的菌株的药敏情况。绘制受试者工作特征曲线（ROC），分析PCT、CRP和白细胞（WBC）在确定不同细菌属引起的感染中的特异性和敏感性。利用基本信息和通过快速检测生物标志物对其他病原菌进行简单鉴定，分析急诊环境中CA-BSI的危险因素。
共有219例患者符合入选标准，其中103例感染革兰氏阳性菌（G+），116例感染革兰氏阴性菌（G-）。GN-BSI组的PCT显著高于GP-BSI组，而两组之间的CRP无显著差异。绘制ROC曲线分析WBC、CRP和PCT，该模型中PCT的曲线下面积（AUC）为0.6661，敏感性=0.798，特异性=0.489。
GP-BSI组和GN-BSI组之间的PCT存在显著差异。结合临床医生的知识和患者的临床体征，PCT应作为一种辅助方法，在临床实践早期初步确定病原体并指导用药。
