Clinical significance of coagulase-negative Staphylococci isolated from blood cultures

中华传染病杂志 Pub Date : 2018-11-15 DOI:10.3760/CMA.J.ISSN.1000-6680.2018.11.004

Tingting Wu, J. Zeng, Xiao-peng Jing, Xiaochun Min

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Abstract

Objective To analyze clinical characteristics of bloodstream infections caused by coagulase-negative Staphylococci (CNS) and antibiotic resistance of the bacteria, so that to provide basis for the clinical diagnosis and treatment. Methods A retrospective analysis of CNS in blood cultures collected from 108 hospitalized patients in Puai Hospital of Tongji Medical College from January 2016 to December 2017 was performed. The antimicrobial susceptibilities were tested by Kirby-Bauer method and E test method. For measurement variables, normally distributed variables were compared using t test, and non-normal distributed data were compared using Mann-Whitney U test. Categorical variables were compared using χ2 test. Results Of the 108 patients, 66 were male and 42 were female; the age range was 26 to 98 years and the average was 49 years. According to the criteria for bacteremia, 36 of 108 (33.3%) patients with CNS-positive blood cultures were diagnosed with bacteremia and 72 (66.7%) cases were contaminated. CNS bacteremia mainly occurred in the intensive care unit and nephropathy ward. Among them, 23 (62.2%) patients were catheter-related blood stream infections, and 11 (29.7%) patients were dialysis catheter-related bloodstream infections. Fifteen of 36 (41.7%) strains were isolated within 48 hours of admission. The level of serum procalcitonin (PCT) for bacteremia patients was 2.56 (1.44, 7.60) μg/L, and that was 0.13 (0.05, 0.23) μg/L in contaminated patients. The difference was statistically significant (Z=8.097, P 0.05). After antibiotic treatment, 26 of 36 bacteremia patients were survived. The PCT levels before antibiotic treatment were 2.05 (1.42, 4.32) μg/L, and 0.24 (0.07, 0.61) μg/L after antibiotic treatment. Serum PCT was decreased significantly after antibiotic treatment (Z=4.457, P 0.05). No significant difference was found in white blood cell count between survivors and deaths at 28 days (t=0.771, P>0.05). There was no statistical difference of the anti-bacterial drug susceptibility between pathogens and contaminants (P>0.05). All strains were sensitive to vancomycin, teicoplanin and linezolid. Conclusions The incidence of CNS contamination in blood culture is relatively high. It is important to distinguish true bacteraemia from contamination by a review of the clinical and laboratory indicators. PCT is of clinical value to indicate CNS infection and to monitor therapeutic effect. Key words: Bacteremia; Coagulase negative Staphylococci; Procalcitonin

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血培养凝固酶阴性葡萄球菌的临床意义

目的分析凝固酶阴性葡萄球菌(CNS)血流感染的临床特点及耐药情况，为临床诊断和治疗提供依据。方法回顾性分析2016年1月至2017年12月同济医学院普爱医院108例住院患者血培养标本的中枢神经系统。采用Kirby-Bauer法和E试验法进行药敏试验。对于计量变量，正态分布变量比较采用t检验，非正态分布数据比较采用Mann-Whitney U检验。分类变量比较采用χ2检验。结果108例患者中，男性66例，女性42例;年龄范围为26岁至98岁，平均年龄为49岁。根据菌血症诊断标准，108例cns阳性血培养患者中36例(33.3%)诊断为菌血症，72例(66.7%)被污染。中枢神经系统菌血症主要发生在重症监护病房和肾病病房。其中导管相关血流感染23例(62.2%)，透析导管相关血流感染11例(29.7%)。36株中有15株(41.7%)在入院48小时内分离。菌血症患者血清降钙素原(PCT)水平为2.56 (1.44,7.60)μg/L，污染患者血清PCT水平为0.13 (0.05,0.23)μg/L。差异有统计学意义(Z=8.097, p0.05)。36例菌血症患者经抗生素治疗后，26例存活。抗生素治疗前PCT水平为2.05 (1.42,4.32)μg/L，抗生素治疗后为0.24 (0.07,0.61)μg/L。抗生素治疗后血清PCT显著降低(Z=4.457, P 0.05)。存活组与死亡组28天白细胞计数无显著差异(t=0.771, P < 0.05)。病原菌与污染物的抗菌药物敏感性比较，差异无统计学意义(P < 0.05)。所有菌株对万古霉素、替可普宁和利奈唑胺敏感。结论血培养中中枢神经系统污染发生率较高。重要的是通过审查临床和实验室指标来区分真正的菌血症和污染。PCT对提示中枢神经系统感染和监测治疗效果有临床价值。关键词:菌血症;凝固酶阴性葡萄球菌;原降钙素

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来源期刊

中华传染病杂志

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发文量

5280

期刊介绍： The Chinese Journal of Infectious Diseases was founded in February 1983. It is an academic journal on infectious diseases supervised by the China Association for Science and Technology, sponsored by the Chinese Medical Association, and hosted by the Shanghai Medical Association. The journal targets infectious disease physicians as its main readers, taking into account physicians of other interdisciplinary disciplines, and timely reports on leading scientific research results and clinical diagnosis and treatment experience in the field of infectious diseases, as well as basic theoretical research that has a guiding role in the clinical practice of infectious diseases and is closely integrated with the actual clinical practice of infectious diseases. Columns include reviews (including editor-in-chief reviews), expert lectures, consensus and guidelines (including interpretations), monographs, short monographs, academic debates, epidemic news, international dynamics, case reports, reviews, lectures, meeting minutes, etc.