Li Yuzhen, Li Yanyan, Wang Jiqin, Sun Keyu
Department of Emergency, Minhang Hospital, Fudan University, Shanghai, China.
Front Cell Infect Microbiol. 2025 Apr 30;15:1525758. doi: 10.3389/fcimb.2025.1525758. eCollection 2025.
Explore and analyze CLABSI pathogenic bacteria characteristics in ICU patients and the value of PCT, NLR, PLR in early infection prediction.
926 ICU patients with central venous catheters in Minhang Hospital from January 2021 to December 2023 were enrolled. They were grouped by co-infection status. PCT, NLR and PLR levels were measured, patient data analyzed, pathogenic bacteria characteristics summarized, and their predictive value evaluated via ROC curve.
From January 2021 to December 2023, among the 926 patients with CVC, 73 were diagnosed with CLABSI, with an infection rate of 7.88%. A total of 81 strains of pathogenic bacteria were isolated, including 60.50% (49/81) Gram - positive bacteria, 35.80% (29/81) Gram - negative bacteria, and 3.70% (3/81) fungi. The main Gram - positive bacteria exhibited high resistance to penicillin, erythromycin, clindamycin, and oxacillin, with a resistance rate exceeding 70%, yet were sensitive to vancomycin, linezolid, and tetracycline. The main Gram - negative bacteria had high resistance to piperacillin, piperacillin/tazobactam, Aztreonam, and gentamicin, with a resistance rate over 70%, and were more sensitive to cefoperazone/sulbactam, imipenem, and amikacin. Age, the site of catheterization, the duration of catheterization, and the employment of double - cavity catheters were all factors that exerted an influence on CLABSI among ICU patients (with p < 0.05). The levels of peripheral blood NLR, PLR, and PCT in the infected group were higher than those in the non - infected group (p < 0.05). The areas under the curve (AUCs) of peripheral blood NLR, PLR, and PCT were 0.814, 0.798, and 0.856, respectively, with the largest AUC for PCT. When the cut - off point was 2.75 ng/ml, the Youden index was the largest. The AUCs of the combination of peripheral blood NLR and PLR, NLR and PCT, PLR and PCT, and all three combined were 0.877, 0.903, 0.857, and 0.917.
The early prediction of CLABSI in ICU patients by means of PCT, NLR, and PLR is of remarkable significance. It can provide a precious reference for clinical diagnostic and treatment strategies.
探讨并分析重症监护病房（ICU）患者中心静脉导管相关血流感染（CLABSI）的病原菌特征以及降钙素原（PCT）、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）在早期感染预测中的价值。
选取2021年1月至2023年12月在闵行医院留置中心静脉导管的926例ICU患者。按合并感染情况分组。检测PCT、NLR和PLR水平，分析患者资料，总结病原菌特征，并通过ROC曲线评估其预测价值。
2021年1月至2023年12月，926例中心静脉导管（CVC）患者中，73例诊断为CLABSI，感染率为7.88%。共分离出81株病原菌，其中革兰阳性菌占60.50%（49/81），革兰阴性菌占35.80%（29/81），真菌占3.70%（3/81）。主要革兰阳性菌对青霉素、红霉素、克林霉素和苯唑西林耐药性高，耐药率超过70%，但对万古霉素、利奈唑胺和四环素敏感。主要革兰阴性菌对哌拉西林、哌拉西林/他唑巴坦、氨曲南和庆大霉素耐药性高，耐药率超过70%，对头孢哌酮/舒巴坦、亚胺培南和阿米卡星更敏感。年龄、置管部位、置管时间和双腔导管的使用均是影响ICU患者CLABSI的因素（p<0.05）。感染组外周血NLR、PLR和PCT水平高于未感染组（p<0.05）。外周血NLR、PLR和PCT的曲线下面积（AUC）分别为0.814、0.798和0.856，PCT的AUC最大。当截断点为2.75 ng/ml时，约登指数最大。外周血NLR与PLR联合、NLR与PCT联合、PLR与PCT联合以及三者联合的AUC分别为0.877、0.903、0.857和0.917。
利用PCT、NLR和PLR对ICU患者CLABSI进行早期预测具有重要意义。可为临床诊断和治疗策略提供宝贵参考。
