摘要
目的分析肺癌患者经外周静脉穿刺中心静脉导管(PICC)置管后发生导管相关血流感染(CBI)的病原学特点,观察血清相关炎性因子变化。方法选取2018年8月-2021年8月于绵阳市安州区人民医院行PICC置管的68例肺癌患者,根据其是否发生CBI分为CBI组(n=23)和未感染组(n=45)。收集患者临床相关资料,分析CBI患者的病原学分布特点及耐药情况。比较两组血清炎症因子C反应蛋白(CRP)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)、白细胞介素-2(IL-2)及γ干扰素(IFN-γ)水平,采用受试者工作特征(ROC)曲线分析血清炎症因子对早期发生CBI的预测价值。结果68例患者置管后有23例发生CBI,感染率为33.82%。共分离培养出53株病原菌,以革兰阴性菌(58.49%)为主。革兰阴性菌和革兰阳性菌普遍对青霉素、氨苄西林、头孢唑林、头孢他啶、阿米卡星的耐药性较高,对亚胺培南、万古霉素的耐药性较低。CBI组的CRP、PCT、TNF-α、IL-2水平均高于未感染组,IFN-γ水平低于未感染组,差异均有统计学意义(t=17.862、9.436、9.396、12.010、11.716,P均<0.05)。ROC曲线分析结果显示,血清炎症因子CRP、PCT、TNF-α、IL-2、IFN-γ联合检测预测肺癌患者PICC置管后发生CBI的曲线下面积(AUC)为0.948,高于CRP、PCT、TNF-α、IL-2、IFN-γ单独预测的0.728、0.783、0.695、0.728、0.775,差异均有统计学意义(P均<0.05)。结论肺癌PICC置管患者发生CBI的病原菌以革兰阴性菌为主,对大多抗生素均有较高的耐药性,临床可通过联合检测血清炎性因子水平变化,预测感染发生。
Objective To analyze the etiological characteristics of catheter-related bloodstream infection(CBI)after peripherally inserted central catheter(PICC)catheterization in lung cancer patients,and observe the changes of serum associated inflammatory factors.Methods A retrospective study was performed on the 68 patients with lung cancer undergoing PICC catheterization in Mianyang Anzhou District People's Hospital between August 2018 and August 2021.According to presence or absence of CBI,they were divided into CBI group(n=23)and non-infection group(n=45).The clinical related data of patients were collected to analyze distribution characteristics and drug resistance of pathogen in CBI patients.The levels of serum inflammation factors[C-reactive protein(CRP),procalcitonin(PCT),tumor necrosis factor-α(TNF-α),interleukin-2(IL-2),γ-interferon(IFN-γ)]were compared between the two groups.The predictive value of serum inflammatory factors for early CBI was analyzed by receiver operating characteristic(ROC)curves.Results Of the 68 patients after catheterization,there were 23 cases(33.82%)with CBI.There were 53 strains of pathogens,mainly Gram-negative bacteria(58.49%).The resistance of Gram-negative bacteria and Gram-positive bacteria was generally high to penicillin,ampicillin,cefazolin,ceftazidime and amikacin,with low resistance to imipenem and vancomycin.The levels of CRP,PCT,TNF-αand IL-2 in CBI group were higher than those in non-infection group,while IFN-γlevel was lower than that in non-infection group,the differences were statistically significant(t=17.862,9.436,9.396,12.010,11.716;P all<0.05).The results of ROC curve analysis showed that area under curve(AUC)of CRP combined with PCT,TNF-α,IL-2 and IFN-γin predicting CBI in patients with lung cancer after PICC was 0.948,significantly greater than that of CRP,PCT,TNF-α,IL-2,IFN-γalone(0.728,0.783,0.695,0.728,0.775),the differences were statistically significant(P all<0.05).Conclusions The main pathogen of CBI was Gram-negative bacteria in patients with lung cancer after PICC catheterization,which was of high resistance to most antibiotics.Clinically,the changes of serum inflammatory factors could be applied to predict infection.
作者
李晓娅
蔡丽丽
何娟
LI Xiaoya;CAI Lili;HE Juan(Department of Respiratory and Critical Care Medicine,Mianyang Anzhou District People's Hospital,Mianyang,Sichuan 622651,China)
出处
《热带医学杂志》
CAS
2023年第3期384-387,409,429,共6页
Journal of Tropical Medicine
基金
绵阳市卫生健康委医学科研课题项目(202072)
关键词
肺癌
经外周静脉穿刺中心静脉置管
导管相关血流感染
炎性因子
Lung cancer
Peripherally inserted central catheter
Catheter-related bloodstream infection
Inflammatory factor
