Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China.
Shock. 2023 Sep 1;60(3):354-361. doi: 10.1097/SHK.0000000000002175. Epub 2023 Aug 8.
Objective: Respiratory infections or colonization of Acinetobacter baumannii (Ab) are common in clinical practice but are treated differently. Early identification of Ab infection and colonization reduces the risk of antibiotic mismatch but objective laboratory indicators to distinguish between bacterial infections and colonization are lacking. To distinguish infection and colonization of Ab, we tested the role of two biomarkers, triggering receptor expressed on myeloid cells-1 (TREM-1) and hemolysin coregulated protein. Methods: A total of 96 inpatients with Ab were divided into infection and colonization groups. Blood samples were collected on days 1, 2, 3, 5, 8, and 10 and daily maximum body temperature was recorded. Polymerase Chain Reaction and Reverse Transcription Polymerase Chain Reaction were used to detect the presence and expression levels of the hcp gene in Ab clinical isolates. Results : sTREM-1 and procalcitonin (PCT) levels on days 1 to 10 and neutrophil classification (N%) on days 1 to 3 were different ( P < 0.05) in the infection group and colonization group. Receiver operating characteristic (ROC) curves showed significant differences in N% and sTREM-1 on days 2 and 3 ( P < 0.01). sTREM-1 had the highest AUC ROC on days 1, 2, and 3 of all the markers. On day 1, the ROC curve of "WBC&N%&PCT&sTREM-1" was statistically different from individual indices (white blood cell count, N%, and PCT; P < 0.05) and was equal to the ROC curve of sTREM-1 ( P > 0.05). Thirty five of 96 patients were classified as infection group and 61 as colonization group with hcp gene detection rates of 71.43% (25/35) and 31.15% (19/61), respectively. No differences in hcp gene presence and transcript levels were found between two groups ( P > 0.05). Conclusions: Dynamic monitoring of sTREM-1 and PCT is valuable in identifying Ab infection and colonization. sTREM-1 can be improved by combination with multiple biomarkers in the early stage for identification of infection and colonization. The hcp gene was more likely to be present in the infection cohort.
在临床实践中，鲍曼不动杆菌（Ab）的呼吸道感染或定植很常见，但治疗方法却有所不同。早期识别 Ab 感染和定植可降低抗生素不匹配的风险，但缺乏区分细菌感染和定植的客观实验室指标。为了区分 Ab 的感染和定植，我们检测了两种生物标志物，即髓系细胞触发受体-1（TREM-1）和溶菌素调节蛋白的作用。方法：将 96 例 Ab 住院患者分为感染组和定植组。分别于第 1、2、3、5、8 和 10 天采集血样，并记录每天的最高体温。聚合酶链反应和逆转录聚合酶链反应用于检测 Ab 临床分离株中 hcp 基因的存在和表达水平。结果：在感染组和定植组中，第 1 至 10 天的可溶性 TREM-1（sTREM-1）和降钙素原（PCT）水平以及第 1 至 3 天的中性粒细胞分类（N%）不同（P<0.05）。受试者工作特征（ROC）曲线显示，第 2 和 3 天的 N%和 sTREM-1 差异具有统计学意义（P<0.01）。在所有标志物中，sTREM-1 在第 1、2 和 3 天的 AUC ROC 最高。在第 1 天，“WBC&N%&PCT&sTREM-1”的 ROC 曲线与单个指标（白细胞计数、N%和 PCT）具有统计学差异（P<0.05），与 sTREM-1 的 ROC 曲线相当（P>0.05）。96 例患者中，35 例被分类为感染组，61 例为定植组，hcp 基因检测率分别为 71.43%（25/35）和 31.15%（19/61）。两组间 hcp 基因的存在和转录水平无差异（P>0.05）。结论：动态监测 sTREM-1 和 PCT 对识别 Ab 感染和定植具有重要价值。sTREM-1 可通过早期与多个生物标志物联合应用，提高对感染和定植的识别能力。hcp 基因在感染组中更易出现。
