Procalcitonin as a marker of Gram-negative bloodstream infections in hematological patients with febrile neutropenia
Procalcitonin as a marker of Gram-negative bloodstream infections in hematological patients with febrile neutropenia
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降钙素原作为发热性中性粒细胞减少症血液病患者革兰氏阴性血流感染的标志物
DOI：
10.1080/10428194.2019.1581928
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发表时间：
2019-08-24
影响因子：
2.6
通讯作者：
Yang, Ting
中科院分区：
文献类型：
--
作者：
Luo, Xiaofeng;Chen, Shaozhen;Yang, Ting
摘要本研究旨在探讨降钙素原（PCT）对发热性中性粒细胞减少的血液病患者发生革兰阴性血流感染（BSI）的预测价值。共纳入1466份样本（396份血培养（BC）阳性、1052份BC阴性和18份污染标本），包括268份革兰氏阴性、88份革兰氏阳性、19份真菌和21份多微生物BSI。革兰氏阴性BSI的PCT中值（0.72 ng/mL; IQR：0.23-3.87）显著高于革兰氏阳性BSI（0.34 ng/mL; IQR：0.14-2.23; p <0.01）或真菌BSI（0.27 ng/mL; IQR：0.13-0.40; p <0.01）。在单一微生物BSI中，区分革兰氏阴性BSI与所有其他发热原因的最佳PCT截止值为0.56 ng/ml，特异性为76.8%。多药耐药（MDR）革兰氏阴性菌株的BSI中PCT水平显著高于非MDR菌株（p <0.01）。本研究证实，PCT升高可预测发热性中性粒细胞减少症血液学患者的革兰氏阴性BSI，并证明这些患者MDR革兰氏阴性BSI中的PCT水平较高。
Abstract The aim of this study was to explore the predictive value of procalcitonin (PCT) in Gram-negative bloodstream infections (BSIs) in hematological patients with febrile neutropenia. A total of 1466 samples (396 blood culture (BC)-positive, 1052 BC-negative, and 18 contaminated specimens) were included, comprising 268 Gram-negative, 88 Gram-positive, 19 fungal, and 21 polymicrobial BSIs. Median PCT value (0.72 ng/mL; IQR: 0.23–3.87) was significantly higher in Gram-negative than Gram-positive (0.34 ng/mL; IQR: 0.14–2.23; p < .01), or fungal (0.27 ng/mL; IQR: 0.13–0.40; p < .01) BSIs. In mono-microbial BSIs, the best PCT cutoff distinguishing Gram-negative BSIs from all other fever causes was 0.56 ng/ml, with a specificity of 76.8%. PCT levels were significantly higher in BSIs from multidrug-resistant (MDR) Gram-negative strains than from non-MDR (p < .01). This study confirms that elevated PCT may predict Gram-negative BSIs in hematological patients with febrile neutropenia, and demonstrates higher PCT levels in MDR Gram-negative BSIs in these patients.