动态监测PCT对神经重症患者抗感染治疗与抗菌药物应用的分析
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摘要
目的研究动态监测血清降钙素原(PCT)对重症监护病房(ICU)神经重症患者抗感染治疗效果与炎症指标及抗菌药物应用情况。方法选取2015年1月-2017年1月ICU神经重症医院感染患者100例为研究对象,根据感染类型、感染程度,参考早期抗菌药物使用经验,按照抗菌药物是否覆盖病原菌的原则,分为72例早期抗菌药物覆盖血培养结果中病原菌的患者为覆盖组,28例早期抗菌药物未完全覆盖血培养结果中病原菌的患者为未完全覆盖组。观察和比较两组患者早期经验使用抗菌药物前、使用第三天、第五天血清PCT、白细胞计数(WBC)、C-反应蛋白(CRP)、中性粒细胞比值(N)水平,计算下降率。结果抗菌药物使用前,两组患者PCT、WBC、CRP、N差异无统计学意义;使用第三天、第五天,覆盖组PCT分别为(5.33±2.30)ng/ml、(1.42±1.07)ng/ml低于未完全覆盖组(P<0.05),而两组WBC、CRP、N,差异无统计学意义。使用第三天、第五天,两组PCT、WBC、CRP、N均低于同组抗菌药物使用前(P<0.05)。抗菌药物使用第三天、第五天,覆盖组PCT下降率为(78.24±8.00)%、(73.36±8.02)%高于未完全覆盖组(P<0.05),两组WBC、CRP、N下降率,差异无统计学意义。ROC曲线显示,使用抗菌药物第三天、第五天,PCT下降率曲线下面积0.965、0.946,高于WBC、CRP、N下降率曲线下面积(P<0.05)。两组患者抗菌药物使用率均为100.00%。覆盖组患者抗菌药物使用时间为(5.60±1.20)d、抗感染总有效率为98.61%(71/72)、病死率为1.39%(1/72)与未完全覆盖组比较差异有统计学意义(P<0.05)。结论动态监测ICU神经重症患者血清PCT水平变化,有助于判断感染风险和感染程度、评定早期抗菌药物治疗效果,为及时调整抗菌药物使用提供参考依据,避免抗菌药物的不合理使用及耐药菌株产生。
OBJECTIVE To investigate the effect of dynamic monitoring of serum procalcitonin(PCT)on anti-infective therapy,inflammatory indexes and antimicrobial application in intensive care unit(ICU)patients with severe neurological disease.METHODS 100 patients with severe neurological nosocomial infection hospitalized in ICU from Jan.2015 to Jan.2017 were enrolled.According to the type of infection and the degree of infection,with reference to the experience of using early antimicrobial agents,the patients were divided into the observation group with 72 cases where the pathogens in the blood culture were covered by the early antimicrobial agents used,and the the control group with 28 cases where the early antimicrobial drug did not completely cover the pathogens in the blood culture.The levels of serum PCT,white blood cell(WBC)count,C-reactive protein(CRP)and neutrophil ratio(N)were observed before use of early antimicrobial drug,as well as on the third day and the fifth day after the antibacterial treatment.And the rate of decrease was calculated.RESULTS Before the use of antimicrobial agents,the levels of PCT,WBC,CRP and N in the observation group were not significantly different from those in the control group.The levels of PCT in the observation group were(5.33±2.30)ng/ml and(1.42±1.07)ng/ml on the third day and the fifth day after use of antimicrobial agents,significantly lower than those in the control group(P<0.05).There were no significant differences in WBC,CRP and N levels between the control group and the control group.The levels of PCT,WBC,CRP and N in the two groups were all significantly lower than those in the same group on the third day and the fifth day after antimicrobial treatment as compared to before use of antimicrobial agents(P<0.05).On the third day and the fifth day of antibacterial drug use,the decline rate of PCT in the observation group was significantly higher than that in the control group(P<0.05).The differences in the decline rates of WBC,CRP and N between the two groups were not significant.The ROC curve showed that the area under the curve of PCT descending rate was 0.965 and 0.946 on the third day and the fifth day,significantly higher than those of the decreasing rates of WBC,CRP and N(P<0.05).Antibiotics use rates in both groups were 100.00%.In the observation group,the use of antimicrobial agents was(5.60±1.20)d,the total effective rate of anti-infection was 98.61%(71/72),and the mortality rate was 1.39%(1/72),all with significant differences with the control group(P<0.05).CONCLUSIONThe dynamic monitoring of serum PCT levels in ICU patients with severe neurological disorders may help to determine the risk of infection and the degree of infection and to evaluate the efficacy of early antimicrobial agents,and may provide reference for timely adjustment of the use of antimicrobial agents and avoid irrational use of antimicrobial agents and generation of drug-resistant organisms.
OBJECTIVE To investigate the effect of dynamic monitoring of serum procalcitonin(PCT)on anti-infective therapy,inflammatory indexes and antimicrobial application in intensive care unit(ICU)patients with severe neurological disease.METHODS 100 patients with severe neurological nosocomial infection hospitalized in ICU from Jan.2015 to Jan.2017 were enrolled.According to the type of infection and the degree of infection,with reference to the experience of using early antimicrobial agents,the patients were divided into the observation group with 72 cases where the pathogens in the blood culture were covered by the early antimicrobial agents used,and the the control group with 28 cases where the early antimicrobial drug did not completely cover the pathogens in the blood culture.The levels of serum PCT,white blood cell(WBC)count,C-reactive protein(CRP)and neutrophil ratio(N)were observed before use of early antimicrobial drug,as well as on the third day and the fifth day after the antibacterial treatment.And the rate of decrease was calculated.RESULTS Before the use of antimicrobial agents,the levels of PCT,WBC,CRP and N in the observation group were not significantly different from those in the control group.The levels of PCT in the observation group were(5.33±2.30)ng/ml and(1.42±1.07)ng/ml on the third day and the fifth day after use of antimicrobial agents,significantly lower than those in the control group(P<0.05).There were no significant differences in WBC,CRP and N levels between the control group and the control group.The levels of PCT,WBC,CRP and N in the two groups were all significantly lower than those in the same group on the third day and the fifth day after antimicrobial treatment as compared to before use of antimicrobial agents(P<0.05).On the third day and the fifth day of antibacterial drug use,the decline rate of PCT in the observation group was significantly higher than that in the control group(P<0.05).The differences in the decline rates of WBC,CRP and N between the two groups were not significant.The ROC curve showed that the area under the curve of PCT descending rate was 0.965 and 0.946 on the third day and the fifth day,significantly higher than those of the decreasing rates of WBC,CRP and N(P<0.05).Antibiotics use rates in both groups were 100.00%.In the observation group,the use of antimicrobial agents was(5.60±1.20)d,the total effective rate of anti-infection was 98.61%(71/72),and the mortality rate was 1.39%(1/72),all with significant differences with the control group(P<0.05).CONCLUSIONThe dynamic monitoring of serum PCT levels in ICU patients with severe neurological disorders may help to determine the risk of infection and the degree of infection and to evaluate the efficacy of early antimicrobial agents,and may provide reference for timely adjustment of the use of antimicrobial agents and avoid irrational use of antimicrobial agents and generation of drug-resistant organisms.
引文
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[12] Cao B,Tan TT,Poon E,et al.Consensus statement on the management of methicillin-resistant Staphylococcus aureus nosocomial pneumonia in Asia[J].Clin Respir J,2015,9(2):129-142.
[13]孙巧松,张晖,栾中钦.血清降钙素原指导神经内科重症患者抗感染的临床价值[J].中国实用医药,2017,12(16):69-70.
[14] Dimarakis I,Paschalis A,Hoschtitzky JA,et al.Central pulmonary thrombosis secondary to severe infection of a right ventricle-to-pulmonary artery conduit[J].Cardiol Young,2013,23(2):265-266.
[15] Tashiro M,Izumikawa K,Ashizawa N,et al.Clinical significance of methicillin-resistant coagulase-negative Staphylococci obtained from sterile specimens[J].Diagn Microbiol Infect Dis,2015,81(1):71-75.
[2] Iqbal N,Irfan M,Khan JA,et al.Hypercapnia as a marker of ICU admission and prolonged hospitalization in patients with community-acquired pneumonia[J].Eur Respir J,2015,46(suppl 59):OA3261.
[3] Becze Z,Molnar Z,Fazakas J.Can procalcitonin levels indicate the need for adjunctive therapies in sepsis?[J].Int J Antimicrob Agents,2015,46(Suppl 1):S13-S18.
[4] Cilloniz C,Torres A,Polverino E,et al.Community-acquired lung respiratory infections in HIV-infected patients:Microb Aetiol Outc[J].Eur Respira J,2014,43(6):1698-1708.
[5]牟娜,李洁,牟佳,等.神经外科重型颅脑损伤患者肺部感染鲍曼不动杆菌的危险因素和耐药性分析[J].中国现代应用药学,2016,33(07):936-940.
[6] Angeletti S,Dicuonzo G,Fioravanti M,et al.Procalcitonin,MR-Proadrenomedullin,and cytokines measurement in sepsis diagnosis:advantages from test combination[J].Dis Markers,2015,2015(10):951532.
[7] Chalmers JD,Akram AR,Singanayagam A,et al.Risk factors for Clostridium difficileinfection in hospitalized patients with community-acquired pneumonia[J].J Infect,2016,73(1):45-53.
[8]中华人民共和国国家卫生和计划生育委员会.医院感染监测规范[S].卫办医政发[2009]126号.
[9]王宇明,施光峰.感染病学.第2版[R].北京:人民卫生出版社,2010:8.
[10] Bassetti M,Righi E,Esposito S,et al.Drug treatment for multidrug-resistant Acinetobacter baumannii infections[J].Future Microbiol,2008,3(6):649-660.
[11] Kirklin JK,Naftel DC,Kormos RL,et al.Interagency registry for mechanically assisted circulatory support(INTERMACS)analysis of pump thrombosis in the Heart Mate II left ventricular assist device[J].J Heart Lung Transplant,2014,33(1):12-22.
[12] Cao B,Tan TT,Poon E,et al.Consensus statement on the management of methicillin-resistant Staphylococcus aureus nosocomial pneumonia in Asia[J].Clin Respir J,2015,9(2):129-142.
[13]孙巧松,张晖,栾中钦.血清降钙素原指导神经内科重症患者抗感染的临床价值[J].中国实用医药,2017,12(16):69-70.
[14] Dimarakis I,Paschalis A,Hoschtitzky JA,et al.Central pulmonary thrombosis secondary to severe infection of a right ventricle-to-pulmonary artery conduit[J].Cardiol Young,2013,23(2):265-266.
[15] Tashiro M,Izumikawa K,Ashizawa N,et al.Clinical significance of methicillin-resistant coagulase-negative Staphylococci obtained from sterile specimens[J].Diagn Microbiol Infect Dis,2015,81(1):71-75.