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中华实验和临床感染病杂志(电子版) ›› 2021, Vol. 15 ›› Issue (01) : 60 -66. doi: 10.3877/cma.j.issn.1674-1358.2021.01.010

所属专题: 文献

论著

血培养阳性报警时间联合未成熟粒细胞及C反应蛋白鉴别儿童凝固酶阴性葡萄球菌血流感染与污染
王淑慧1, 刘海英1,(), 林敏纯1, 谌亚星1, 邓秋连1, 钟华敏1, 关小珊1, 姚淑雯1, 曾兰兰1   
  1. 1. 510120 广州市,广州医科大学附属广州市妇女儿童医疗中心检验科
  • 收稿日期:2020-03-18 出版日期:2021-02-15
  • 通信作者: 刘海英
  • 基金资助:
    广州市科技创新委员会项目(No. 201804010447)

Evaluation on time of positivity for blood culture combined with immature granulocytes and C-reactive protein to identify bloodstream infection from contamination with coagulase-negative Staphylococci in pediatric patients

Shuhui Wang1, Haiying Liu1,(), Minchun Lin1, Yaxing Chen1, Qiulian Deng1, Huamin Zhong1, Xiaoshan Guan1, Shuwen Yao1, Lanlan Zeng1   

  1. 1. Clinical Laboratory, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510120, China
  • Received:2020-03-18 Published:2021-02-15
  • Corresponding author: Haiying Liu
引用本文:

王淑慧, 刘海英, 林敏纯, 谌亚星, 邓秋连, 钟华敏, 关小珊, 姚淑雯, 曾兰兰. 血培养阳性报警时间联合未成熟粒细胞及C反应蛋白鉴别儿童凝固酶阴性葡萄球菌血流感染与污染[J/OL]. 中华实验和临床感染病杂志(电子版), 2021, 15(01): 60-66.

Shuhui Wang, Haiying Liu, Minchun Lin, Yaxing Chen, Qiulian Deng, Huamin Zhong, Xiaoshan Guan, Shuwen Yao, Lanlan Zeng. Evaluation on time of positivity for blood culture combined with immature granulocytes and C-reactive protein to identify bloodstream infection from contamination with coagulase-negative Staphylococci in pediatric patients[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2021, 15(01): 60-66.

目的

评估血培养阳性报警时间(TTP)与血液未成熟粒细胞百分比(IG%)、未成熟粒细胞计数(IG#)、C反应蛋白(CRP)、白细胞总数(WBC)和中性粒细胞百分比(NE%)等炎症指标联合检测对儿童凝固酶阴性葡萄球菌(CoNS)血流感染与污染的鉴别诊断价值。

方法

回顾性分析广州市妇女儿童医疗中心2019年1月~12月收集的12 897份住院患儿血培养资料。根据美国疾病控制与预防中心2016年发布的医院感染监测定义,分为CoNS感染组(132例)和CoNS污染组(124例);以同期分离出金黄色葡萄球菌病例为感染阳性对照(SA对照组,27例)。通过ROC曲线分析TTP联合以上炎症指标对鉴别CoNS感染与污染的应用价值。

结果

从血培养中分离出来的256株CoNS中以人葡萄球菌(76株、55.1%)、表皮葡萄球菌(38株、32.0%)和头状葡萄球菌(10株、7.0%)为常见,感染组与污染组CoNS种类构成比差异无统计学意义(χ2 = 6.0、P = 0.647)。3组患者TTP、CRP、WBC、IG%、IG#及NE%差异均具有统计学意义(H = 82.7、13.0、11.3、25.8、25.7、8.5,P均< 0.05)。CoNS感染组TTP显著早于污染组[22.4(17.6,31.1) h vs. 31.1(25.3,41.3)h、U = 496.0、P < 0.001],IG% [0.5(0.3,0.8)vs. 0.3(0.2,0.5)、U = 1 603.5、P < 0.001]、IG# [0.04 (0.02,0.09)× 109/L vs. 0.03 (0.02,0.05)× 109/L、U = 1 767.0、P < 0.001]、CRP [9.0(1.1,32.1)mg/L vs. 4.2 (0.6,15.4)mg/L、U = 1 964.0、P = 0.001]、NE% [48(32.8,65.0) vs. 44 (28.5,59.5)、U = 2445.0、P = 0.036]水平则均显著高于污染组,而两组患者WBC计数差异无统计学意义[10.1(6.9,13.3) vs. 9.2(7.0,11.6)× 109/L、U = 2 907.5、P = 0.645];CoNS感染组与SA对照组各指标差异均无统计学意义(P均> 0.05)。CoNS污染组与SA对照组各指标差异均有统计学意义(P均< 0.05)ROC曲线分析显示,TTP鉴别CoNS感染与污染的曲线下面积最高(AUC = 0.913),当最佳临界值为23.9 h时,灵敏度和特异性分别为82.7%和85.2%;其次是IG%,AUC为0.712,最佳临界值为0.55%,灵敏度和特异性达51.9%和79.7%;IG#、CRP和NE%的AUC则分别为0.679、0.645和0.595,均低于0.7。TTP与IG%和CRP联合判断,AUC、灵敏度和特异性可提高至0.972?88.3%和94.2%,准确度达91.4%,阳性预测值和阴性预测值则分别为92.2%和87.0%。

结论

儿童血培养鉴定为凝固酶阴性葡萄球菌的阳性报警时间在24 h内提示血流感染的可能,而与IG%和CRP联合判断更能提高感染与污染的鉴别准确性。

Objective

To evaluate the value on time to positivity (TTP) for blood culture combined with inflammatory parameters including immature granulocytes percentage (IG%), immature granulocyte count (IG#), C-reactive protein (CRP), white blood cells count (WBC) and neutrophil percentage (NE%) to identify bloodstream infection from contamination with coagulase-negative Staphylococci (CoNS) in pediatric patients.

Methods

Data of 12 897 inpatients with blood culture from January to December 2019 in Guangzhou Women and Children’s Medical Center, Guangzhou Medical University were collected and analyzed, retrospectively. According to the definition of nosocomial infection surveillance issued by Centers for Disease Control and Prevention of the United States in 2016, they were divided into CoNS infection group (132 cases) and CoNS contamination group (124 cases). Cases with Staphylococcus aureus positive at the same period were collected as positive control (SA group, 27 cases). ROC curve was used to analyze the application value of TTP combined with the above-mentioned inflammatory parameters to distinguish CoNS infection from contamination.

Results

Among the 256 strains of CoNS isolated from bloodstream, the top three common strains were Staphylococcus hominis (76 cases, 55.1%), Staphylococcus epidermidis (38 cases, 32.0%) and Staphylococcus capitis (10 cases, 7.0%). There was no significant difference of CoNS subspecies distribution between CoNS infection group and CoNS contamination group (χ2= 6.0, P = 0.647). The parameters TTP, CRP, WBC, IG%, IG# and NE% of the three groups were significantly different (H = 82.7, 13, 11.3, 25.8, 25.7, 8.5; all P < 0.05). TTP of CoNS infection group was significantly lower than that of contamination group [22.4 (17.6, 31.1) h vs. 31.1 (25.3, 41.3) h; U = 496.0, P < 0.001]. IG% [0.5 (0.3, 0.8) vs. 0.3 (0.2, 0.5); U = 1 603.5, P < 0.001], IG# [0.04 (0.02, 0.09) × 109/L vs. 0.03 (0.02, 0.05) × 109/L; U = 1 767.0, P < 0.001], CRP [9.0 (1.1, 32.1) mg/L vs. 4.2 (0.6, 15.4) mg/L; U = 1 964.0, P = 0.001], NE% [48 (32.8, 65.0) vs. 44 (28.5, 59.5); U = 2 445.0, P = 0.036] were higher than those of contaminattion group, while WBC [10.1 (6.9, 13.3) vs. 9.2 (7.0, 11.6) × 109/L] was not significantly different between the two groups (U = 2 907.5, P = 0.645). There was no statistical difference of those parameters between CoNS infection group and SA control group (all P > 0.05). There was significant difference in those parameters between CoNS contamination group and SA control group (all P < 0.05). ROC analysis showed that the value of TTP in identifying CoNS infection from contamination was the biggest area under the curve (AUC = 0.913) and the sensitivity and specificity were 82.7% and 85.2%, respectively, at the optimal Cut-off value of 23.9 hours. It was followed by IG% (AUC = 0.712), with the optimal critical value of 0.55%, the sensitivity of 51.9% and specificity of 79.7%. All the AUC of IG#, CRP and NE% were less than 0.7. The combination of TTP with IG% and CRP could improve the AUC, sensitivity, specificity, accuracy, PPV and NPV to 0.972, 88.3%, 0.942, 91.4%, 92.2% and 87.0%, respectively.

Conclusions

TTP within 24 hours indicates the possibility of CoNS as the pathogenic agent in blood culture for pediatric patients, and the combination of TTP with IG% and CRP could improve the diagnostic accuracy.

表1 入组患儿的一般资料
表2 CoNS感染组和污染组患儿所分离凝固酶阴性葡萄球菌种类[株(%)]
表3 CoNS感染组、污染组和SA对照组的TTP和炎症指标[M(P25,P75)]
图1 TTP与炎症指标诊断CoNS血流感染与污染的ROC曲线图
表4 TTP与各炎症指标对CoNS血流感染和污染的鉴别效能
表5 联合指标鉴别CoNS血流感染与污染的效能评价
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