摘要
为了解多耐药菌(multi drug resistant,MDR)感染的社区获得性肺炎(community-acquired pneumonia,CAP)患者中降钙素原(procalcitonin,PCT)水平。通过回顾性分析方法研究了不同MDR风险组及MDR病原体组PCT水平。按PES评分表,将338例CAP患者分为低、中、高风险MDR组。依据患者病原学培养及药敏结果,分为MDR病原体组和非MDR病原体组。比较所有患者一般资料、降钙素原水平及其他炎性指标等,比较各组间的差异,分析PCT与PES评分之间的关系。使用Logistic回归分析感染MDR病原体的危险因素。结果表明低、中、高风险MDR组PCT水平依次降低,病原学阳性MDR组PCT水平低于非MDR组PCT水平;MDR病原体组患者18人,共检测出菌株23株,其中革兰阴性菌21株,以铜绿假单胞菌多见,革兰阳性菌1株,真菌1株;非MDR病原体组患者17人,共检测出菌株25株,其中革兰阴性菌13株,以大肠埃希菌多见,革兰阳性菌7株,真菌5株;病原学阳性的MDR组患者,以男性较多见,年龄较大,多合并有慢性肺部疾病基础病,多具有近期抗生素使用史,死亡率较高;PCT水平与PES评分负相关(r_s=-0.25,P<0.05),即感染MDR的风险高时,PCT水平反而不高;多因素Logistic回归分析结果发现,年龄和既往90 d内抗生素使用史是MDR病原体感染的独立危险因素。可见对于年龄较大,近期有抗生素使用史的CAP患者,其PCT水平升高不明显,临床上依据PCT水平指导抗生素治疗时,需考虑PCT水平低时存在的感染,尤其是MDR病原体感染的可能。
To understand the clinical value of procalcitonin(PCT) in community-acquired pneumonia(CAP) patients with multi-drug resistant(MDR)pathogens, retrospective analysis was performed to investigate the PCT levels of different MDR risk groups and the MDR pathogen group. In terms of PES rating scale, 338 patients with CAP were divided into low-risk, medium-risk, and high-risk MDR groups. According to the results of pathogen culture and drug susceptibility test, patients were divided into MDR group and non-MDR group. The patients general information and inflammation indictors were detected. The difference between groups were compared, the relationship between PCT and PES scores and the risk factors for infection with MDR pathogens were analyzed using logistic regression. The results show that the PCT level of the low-risk, medium-risk, and high-risk MDR groups decrease successively, and the PCT level of the MDR group is lower than that of the non-MDR group. Twenty-three strains are detected in 18 patients in the MDR pathogen group, of which 21 are Gram-negative bacteria;most of them were Pseudomonas aeruginosa, and one Gram positive bacterium, and one fungus. In addition, from 17 patients in the non-MDR pathogen group, 25 strains are detected, including 13 Gram-negative strains, mostly are Escherichia coli, 7 strains of Gram-positive bacteria, and 5 strains of fungus. Compared with the non-MDR group, the patients in the MDR group are mainly male, older, with more complicated underlying chronic pulmonary diseases, and higher mortality, and most had recent antibiotic use. PCT levels are negatively associated with PES score(r_s=-0.25, P<0.05). In other words, PCT levels are not high when the risk of MDR infection is high. As shown in the logistic regression analysis, the age and antibiotic use in recent 90 days are the independent risk factors of infection with MDR pathogens. For CAP patients who are older and has a recent history of antibiotic intake, the PCT level do not increase considerably. Therefore, in clinical practice, when guiding antibiotic treatment based on the PCT level, it is necessary to consider the infection that exists when the PCT level is low, especially the possibility of MDR pathogen infection.
作者
吴思燕
张淼
陈碧
李元芹
朱洁晨
朱述阳
WU Si-yan;ZHANG Miao;CHEN Bi;LI Yuan-qin;ZHU Jie-chen;ZHU Shu-yang(The Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China)
出处
《科学技术与工程》
北大核心
2020年第18期7199-7205,共7页
Science Technology and Engineering
基金
第十五批“六大人才高峰”高层次人才选拔培养资助方案(WSN-081)
江苏省青年医学重点人才基金资助项目(QNRC2016798)。
关键词
社区获得性肺炎
降钙素原
感染
多重耐药
community-acquired pneumonia
procalcitonin
infection
multi drug resistant
作者简介
第一作者:吴思燕(1994-),女,汉族,江苏宿迁人,硕士研究生。研究方向:肺炎诊疗。E-mail:1518288942@qq.com;通信作者:朱述阳(1963-),男,汉族,江苏徐州人,硕士,主任医师,教授。研究方向:呼吸系病学。E-mail:xyfyzsy@163.com。
