儿童单中心血流感染病原分布与CPR、PCT指标相关分析

Analysis of Correlation between Pathogen Distribution and CPR, PCT Indexes of Single Center Blood Flow Infection in Children

摘要: 目的：分析不同年龄住院儿童血培养病原菌分布及耐药性，探讨血清降钙素原(PCT)和C反应蛋白(CRP)预测阳性指标的临床价值。方法：回顾性分析2017年1月1日至2020年9月30日于青岛大学附属医院住院的<14岁行细菌培养的儿童375名。总结其病原菌及耐药分布，并分析血培养结果阳性与阴性的CRP、PCT水平。结果：共收集375名儿童血培养，阳性55例(14.6%)，阴性320例，其中革兰氏阳性菌39例(70.9%)，以凝固酶阴性的葡萄球菌为主，革兰氏阴性菌16例(29.1%)，以肺炎克雷伯亚种为主。革兰氏阳性菌中对青霉素、红霉素、头孢西丁、苯唑西林耐药率高，革兰氏阴性菌中对三代头孢、氨苄西林有一定耐药。血培养阳性的患儿PCT、CRP水平高于培养阴性的对象，血培养为革兰氏阳性菌患儿PCT低于革兰氏阴性菌患儿的PCT (P < 0.05)。结论：本单中心患儿(0~14岁)儿童血培养以革兰氏阳性菌感染为主，CRP对鉴别病原菌种类无统计学意义，PCT对鉴别病原菌种类有一定价值，CRP、PCT对鉴别血流感染有一定价值。血流感染与非血流感染CRP最佳临界值为12.16 mg/L，敏感度与特异度分别为67.3%和67.9%；PCT最佳临界值为0.40 ng/L，敏感度与特异度分别为58.2%和80.8% (P < 0.05)。

Abstract: Object: To analyze the distribution and drug resistance of pathogenic bacteria in blood culture of hospitalized children of different ages, and to explore the clinical value of predicting positive indexes of serum procalcitonin (PCT) and C-reactive protein (CRP). Methods: A total of 375 children under 14 years old who were hospitalized in the Affiliated Hospital of Qingdao University from January 1, 2017 to September 30, 2020 were analyzed retrospectively. The distribution of pathogens and drug resistance was summarized, and the levels of CRP and PCT with positive and negative blood culture results were analyzed. Results: A total of 375 children were collected for blood culture; 55 cases (14.6%) were positive and 320 cases were negative, including 39 cases of Gram-positive bacteria (70.9%), mainly coagulase-negative staphylococci, 16 cases of Gram-negative bacteria (29.1%), mainly Klebsiella pneumoniae. The resistance rate of Gram-positive bacteria to penicillin, erythromycin, cefoxitin and oxacillin was high, while Gram-negative bacteria were resistant to the third generation cephalosporins and ampicillin. The levels of PCT and CRP in children with positive blood culture were higher than those with negative culture, and the PCT of children with Gram-positive bacteria was lower than that of children with Gram-negative bacteria (PCT (P < 0.05). Conclusion: The blood culture of children (0~14 years old) in this single center is mainly infected by Gram-positive bacteria. CRP has no statistical significance in identifying the types of pathogens. PCT has a certain value in identifying the types of pathogens, and CRP and PCT have a certain value in distinguishing bloodstream infections. The optimal critical value of CRP for bloodstream infection and non-bloodstream infection is 12.16 mg/L, and the sensitivity and specificity are 67.3% and 67.9%, respectively. The optimal critical value of PCT was 0.40 ng/L, and the sensitivity and specificity were 58.2% and 80.8%, respectively.