目的 分析血流感染（BSI）患者血小板参数的动态变化及其在患者预后中的价值。方法 回顾性分析南通市中西医结合医院检验科明确BSI的66例患者,分为生存组（55例）和死亡组（11例）。比较不同组间病原菌分布及1周内血小板参数动态变化情况,并通过Logistic回归分析评估血小板参数动态变化的在治疗预后评估中的价值。结果 （1）BSI患者病原菌分为革兰氏阳性菌（G+）25株、革兰氏阴性菌（G-）39株、真菌2株;G+病原菌中前三位为金黄色葡萄球菌（10.61%）、表皮葡萄球菌（7.58%）、头状葡萄球菌（4.55%）;G-病原菌中前三位为大肠埃希菌（24.24%）、肺炎克雷伯菌肺炎亚种（15.15%）、肠炎沙门菌血清型（3.03%）;真菌为新生隐球酵母（1.52%）、光滑假丝酵母（1.52%）。（2）生存组序贯性器官功能衰竭评分（SOFA）评分为（3.24±0.53）分,低于死亡组的（6.02±1.17）分（t=12.535,P<0.001）;生存组BSI病程为（20.50±2.17）d,低于死亡组的（25.71±4.81）d（t=3.352,P<0.001）;生存组肺部原发感染灶30.91%,高于死亡组的63.64%（χ²=4.243,P=0.039）;生存组最大平均血小板体积（MPV）为（10.96±1.58）fL,低于死亡组的（11.99±1.42）fL（t=2.004,P=0.049）;生存组入院血小板计数（PLT）为（144.33±23.18）10⁹/L,低于死亡组的（166.91±20.29）10⁹/L（t=3.005,P=0.004）;生存组最低PLT为（113.48±30.76）10⁹/L,高于死亡组的（80.16±38.24）10⁹/L（t=3.148,P=0.002）。（3）两组入院及BSI时、BSI后4 d内的指标比较差异均无统计学意义（P>0.05）,在BSI后的5~7 d,生存组PLT为（210.83±102.37）10⁹/L,高于死亡组的（112.75±116.84）10⁹/L（t=2.835,P=0.006）;生存组MPV为（10.12±1.58）fL,低于死亡组的（11.27±1.85）fL（t=2.142,P=0.036）;生存组MPV/PLT 比值（MPR）为（5.69±2.89）,低于死亡组的（11.64±8.23）（t=4.290,P<0.001）。（4）多因素Logistic回归分析发现,入院SOFA（OR=5.461,95%CI：1.544~19.319,P=0.008）、BSI病程（OR=0.773,95%CI：0.622~0.960,P=0.020）、5~7 d MPR（OR=18.976,95%CI：1.776~202.709,P=0.015）是BSI的预测因素。结论 BSI患者血小板参数动态变化较为明显,而入院SOFA、BSI病程、5~7 d MPR对于预测患者死亡风险有重要意义。

目的 研究未成熟血小板分数(IPF)、高荧光未成熟血小板比例(H-IPF)指标在血流感染中的早期诊断价值。方法 选取2020年7月—2021年1月广州市第一人民医院的血培养阳性患者100例作为主要的研究对象,重症病人对照50例,健康对照50例。收集各组患者IPF、H-IPF、大型血小板比率(P-LCR)、血小板体积分布宽度(PDW)、粒/淋、粒/单指标的数值,采用单因素方差分析、构建ROC曲线的方法分析比较各组的IPF、H-IPF、P-LCR、PDW、粒/淋、粒/单比值的差异及其与血流感染效能的关系。结果 IPF、H-IPF、粒/淋、粒/单比值在血流感染组高于其他2组,差异有统计学意义(χ²分别是15.190,10.250,39.490,12.850;P<0.05),而 P-LCR、PDW在3组之间无统计学意义。其中,IPF与H-IPF对血流感染诊断效能较高,其中IPF的AUC为0.855(95% CI为0.737～0.973),H-IPF的AUC为0.845(95% CI为0.722～0.968)。结论 IPF、H-IPF与血流感染密切相关,这2个指标对血流感染患者具有一定的诊断价值。

Objective To explore the early diagnosis value of immature platelet fraction (IPF) and high fluorescent immature platelet fraction (H-IPF) in bloodstream infection.Methods A total of 100 patients with positive blood culture result from July 2020 to January 2021 in Guangzhou First People's Hospital were selected as the research objects,in the mean while,50 critically ill patients and 50 healthy patients were enrolled as two control groups.The values of IPF,H-IPF,platelet-large cell rate (P-LCR),platelet distribution width (PDW),neutrophils/lymphocytes,neutrophils/monocyte ratio of patients in each group were collected,and one-way analysis of variance and ROC curve were used to compare the data,to further analyze their relationship with the bloodstream infection.Results The IPF,H-IPF,neutrophils/lymphocytes,neutrophils/monocyte ratio in the bloodstream infection group were significantly higher than control groups,with statistical significance (χ²=15.190,10.250,39.490,12.850; P<0.05),while P-LCR and PDW had no statistical significance.Among them,IPF and H-IPF were highly effective in diagnosing bloodstream infection,the AUC of IPF was 0.855 (95% CI: 0.737-0.973) and the AUC of H-IPF was 0.845 (95% CI: 0.722-0.968).Conclusions IPF and H-IPF were closely related to bloodstream infection,and these two indicators had a certain value in diagnosing patients with bloodstream infection.

目的 探讨血培养分离菌的分布特点及耐药性,为临床科室诊治血流感染疾病和控制感染提供重要的参考依据。方法 收集某院2016—2020年血培养阳性样本,采用细菌鉴定和药敏分析系统检测,用WHONET 5.6软件进行病原菌分布特点及药敏结果的整理分析。结果 从血培养阳性标本分离出非重复菌3 424株,主要来自老年病科、危重症监护室、急诊留观室等。其中革兰阴性菌1 873株,常见有大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌等。近五年超广谱β-内酰胺酶革兰阴性耐药菌呈缓慢上升趋势,其余耐药菌变化趋势不大。革兰阴性菌对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、头孢他啶、头孢吡肟、庆大霉素、妥布霉素、阿米卡星等总体耐药率均＜30%。革兰阳性菌1 328株,主要是葡萄球菌属,对达托霉素、替加环素均无耐药,对利奈唑胺、万古霉素、替考拉宁耐药率处于较低水平,对复方新诺明和克林霉素等的耐药率近五年呈缓慢下降趋势。结论 血流感染主要常见分离菌为肠杆菌属和葡萄球菌属,临床应重视早期规范血培养和药敏结果,科学合理规范使用抗菌药。

Objective To investigate the distribution characteristics and drug resistance of isolates from blood culture, and to provide important reference for the diagnosis and treatment of bloodstream infection and infection control in clinical practice. Methods Positive blood culture samples of a hospital from 2016 to 2020 were collected and detected by bacteria identification and drug sensitivity analysis system. The distribution characteristics of pathogenic bacteria and drug sensitivity results were analyzed by WHONET 5.6 software. Results A total of 3 424 non-repeating strains were isolated from positive blood culture specimens, which were mainly from geriatrics department, critical care unit, emergency observation room, etc.Among them, 1 873 strains of Gram-negative bacteria were found, including Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. In recent five years, the extended-spectrum beta-lactamases Gram-negative drug resistant bacteria was slowly increasing, while other drug resistant bacteria showed little change. The overall drug resistance rates of Gram-negative bacteria to cefoperazone/sulbactam, piperacillin/tazobactam, ceftazidime, cefepime, gentamicin, tobramycin and amicacin were all less than 30%. There were 1 328 Gram-positive strains, mainly Staphylococcus, showed no resistance to datoromycin and tegacycline, and the resistance rates to linezolid, vancomycin and teicolanin were at a low level, while the resistance rates to cotrimoxazole and clindamycin showed a slow declining trend in recent five years. Conclusion Enterobacteria and Staphylococcus were the most common isolates of bloodstream infection. In clinical practice, attention should be paid to the early blood culture and drug sensitivity results, and the antimicrobial drugs should be used scientifically and rationally.