Infection: C-反应蛋白和降钙素原浓度水平可以指导 COVID-19 患者的抗生素使用

2021-10-19 MedSci原创 MedSci原创

新冠肺炎自2019年底爆发以来造成了全世界范围内的传播,截至 2020 年 12 月 15 日,全球已确认超过 7600 万例 COVID-19 病例和超过 160 万例死亡。

      新冠肺炎自2019年底爆发以来造成了全世界范围内的传播,截至 2020 年 12 月 15 日,全球已确认超过 7600 万例 COVID-19 病例和超过 160 万例死亡。尽管绝大多数人只有轻度症状或无并发症,但也有一部分患者出现了需要住院治疗的严重疾病表型。在美国,普通病房中 COVID-19 患者确诊合并细菌感染的患病率为 3.5%,ICU 患者的合并感染率从 14%到50%不等。血清降钙素原 (PCT) 有助于识别COVID-19患者的继发感染,一些研究已经证明 PCT 水平与 COVID-19 住院患者的细菌合并感染有关。同时,COVID-19 患者的 CRP 通常在就诊时就会升高,由于 CRP 持续升高,该生物标志物可能对 COVID-19 初始阶段的细菌感染没有预测价值。但随时间推移而升高或降低的CRP 可能有助于识别或排除院内细菌感染,并提示适当使用抗生素治疗。因此,本项研究旨在探究C-反应蛋白和降钙素原浓度水平是否可以用作COVID-19 患者的抗生素使用的判断指标。

 

      研究人员对 2020年3月6日至10月30日期间因 COVID-19 入院的患者进行了一项回顾性研究。对患者背景、临床病程、实验室检查结果(重点关注 PCT 和 CRP 水平)以及微生物学结果进行了评估。研究人员主要比较了与 PCT 和 CRP 相关的继发性细菌感染和无继发性细菌感染的患者之间的差异。

 

      研究结果显示:在 99 名 COVID-19 住院患者(52 名 ICU,47 名非 ICU 患者)中,32 名(32%)在住院期间出现继发性细菌感染。继发性细菌感染患者在入院和住院期间的PCT(0.4 VS 0.1 ng/mL;p= 0.016)和 CRP(131 VS 73 mg/L;p= 0.001)水平较高。普通病房的大多数患者(占93%)没有继发性细菌感染。超过一半的入住 ICU 的患者出现继发性细菌感染(56%)。CRP和继发感染产生的AUC分别为 0.88 ( p  < 0.001)和0.86 ( p < 0.001)。PCT 最佳截断值为0.55 ng/mL,灵敏度为 91%,特异性为 81%;CRP 最佳截断值是172 mg/L ,灵敏度为81%,特异性为76%。

 

      本项研究证实COVID-19 患者入院时和病程中的PCT和CRP浓度水平有助于识别继发性细菌感染并指导抗生素治疗的使用。

 

 

原始出处:

Isabell Pink. Et al. C-reactive protein and procalcitonin for antimicrobial stewardship in COVID-19. Infection.2021.

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  5. [GetPortalCommentsPageByObjectIdResponse(id=1685173, encodeId=67d916851e343, content=<a href='/topic/show?id=9bc05542024' target=_blank style='color:#2F92EE;'>#抗生素使用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55420, encryptionId=9bc05542024, topicName=抗生素使用)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=765028091178, createdName=yangfl15, createdTime=Thu Mar 10 13:48:20 CST 2022, time=2022-03-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1277905, encodeId=77cf12e7905aa, content=<a href='/topic/show?id=464c98221e9' target=_blank style='color:#2F92EE;'>#降钙素原#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98221, encryptionId=464c98221e9, topicName=降钙素原)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d521144, createdName=wrj0121, createdTime=Thu Oct 21 01:48:20 CST 2021, time=2021-10-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1524464, encodeId=31ce15244640b, content=<a href='/topic/show?id=f0f998396d' target=_blank style='color:#2F92EE;'>#Infection#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9839, encryptionId=f0f998396d, topicName=Infection)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=76e211601877, createdName=lidong44, createdTime=Thu Oct 21 01:48:20 CST 2021, time=2021-10-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1544704, encodeId=b8f31544e0433, content=<a href='/topic/show?id=ac3d6549e75' target=_blank style='color:#2F92EE;'>#浓度#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65497, encryptionId=ac3d6549e75, topicName=浓度)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=16b213663040, createdName=12498974m55暂无昵称, createdTime=Thu Oct 21 01:48:20 CST 2021, time=2021-10-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1575048, encodeId=db8615e504870, content=<a href='/topic/show?id=b265388684' target=_blank style='color:#2F92EE;'>#C-反应蛋白#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3886, encryptionId=b265388684, topicName=C-反应蛋白)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ab8416056084, createdName=szhvet, createdTime=Thu Oct 21 01:48:20 CST 2021, time=2021-10-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1061817, encodeId=7b27106181ea3, content=跑过来学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6b042465018, createdName=12426349m50暂无昵称, createdTime=Tue Oct 19 13:33:25 CST 2021, time=2021-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1061809, encodeId=1916106180908, content=可以可以, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210713/ff538698164142c3a7d141196bf907b0/2eaf9277e66a41d493ac6d8a4f84b003.jpg, createdBy=1ba35540722, createdName=胸心外科小医生, createdTime=Tue Oct 19 13:25:47 CST 2021, time=2021-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1061785, encodeId=e4261061e852c, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d642002582, createdName=lgbabe, createdTime=Tue Oct 19 11:57:16 CST 2021, time=2021-10-19, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1685173, encodeId=67d916851e343, content=<a href='/topic/show?id=9bc05542024' target=_blank style='color:#2F92EE;'>#抗生素使用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55420, encryptionId=9bc05542024, topicName=抗生素使用)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=765028091178, createdName=yangfl15, createdTime=Thu Mar 10 13:48:20 CST 2022, time=2022-03-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1277905, encodeId=77cf12e7905aa, content=<a href='/topic/show?id=464c98221e9' target=_blank style='color:#2F92EE;'>#降钙素原#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98221, encryptionId=464c98221e9, topicName=降钙素原)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d521144, createdName=wrj0121, createdTime=Thu Oct 21 01:48:20 CST 2021, time=2021-10-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1524464, encodeId=31ce15244640b, content=<a href='/topic/show?id=f0f998396d' target=_blank style='color:#2F92EE;'>#Infection#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9839, encryptionId=f0f998396d, topicName=Infection)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=76e211601877, createdName=lidong44, createdTime=Thu Oct 21 01:48:20 CST 2021, time=2021-10-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1544704, encodeId=b8f31544e0433, content=<a href='/topic/show?id=ac3d6549e75' target=_blank style='color:#2F92EE;'>#浓度#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65497, encryptionId=ac3d6549e75, topicName=浓度)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=16b213663040, createdName=12498974m55暂无昵称, createdTime=Thu Oct 21 01:48:20 CST 2021, time=2021-10-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1575048, encodeId=db8615e504870, content=<a href='/topic/show?id=b265388684' target=_blank style='color:#2F92EE;'>#C-反应蛋白#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3886, encryptionId=b265388684, topicName=C-反应蛋白)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ab8416056084, createdName=szhvet, createdTime=Thu Oct 21 01:48:20 CST 2021, time=2021-10-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1061817, encodeId=7b27106181ea3, content=跑过来学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6b042465018, createdName=12426349m50暂无昵称, createdTime=Tue Oct 19 13:33:25 CST 2021, time=2021-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1061809, encodeId=1916106180908, content=可以可以, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210713/ff538698164142c3a7d141196bf907b0/2eaf9277e66a41d493ac6d8a4f84b003.jpg, createdBy=1ba35540722, createdName=胸心外科小医生, createdTime=Tue Oct 19 13:25:47 CST 2021, time=2021-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1061785, encodeId=e4261061e852c, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d642002582, createdName=lgbabe, createdTime=Tue Oct 19 11:57:16 CST 2021, time=2021-10-19, status=1, ipAttribution=)]
    2021-10-19 12426349m50暂无昵称

    跑过来学习学习

    0

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    2021-10-19 胸心外科小医生

    可以可以

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1685173, encodeId=67d916851e343, content=<a href='/topic/show?id=9bc05542024' target=_blank style='color:#2F92EE;'>#抗生素使用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55420, encryptionId=9bc05542024, topicName=抗生素使用)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=765028091178, createdName=yangfl15, createdTime=Thu Mar 10 13:48:20 CST 2022, time=2022-03-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1277905, encodeId=77cf12e7905aa, content=<a href='/topic/show?id=464c98221e9' target=_blank style='color:#2F92EE;'>#降钙素原#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98221, encryptionId=464c98221e9, topicName=降钙素原)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d521144, createdName=wrj0121, createdTime=Thu Oct 21 01:48:20 CST 2021, time=2021-10-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1524464, encodeId=31ce15244640b, content=<a href='/topic/show?id=f0f998396d' target=_blank style='color:#2F92EE;'>#Infection#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9839, encryptionId=f0f998396d, topicName=Infection)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=76e211601877, createdName=lidong44, createdTime=Thu Oct 21 01:48:20 CST 2021, time=2021-10-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1544704, encodeId=b8f31544e0433, content=<a href='/topic/show?id=ac3d6549e75' target=_blank style='color:#2F92EE;'>#浓度#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65497, encryptionId=ac3d6549e75, topicName=浓度)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=16b213663040, createdName=12498974m55暂无昵称, createdTime=Thu Oct 21 01:48:20 CST 2021, time=2021-10-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1575048, encodeId=db8615e504870, content=<a href='/topic/show?id=b265388684' target=_blank style='color:#2F92EE;'>#C-反应蛋白#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3886, encryptionId=b265388684, topicName=C-反应蛋白)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ab8416056084, createdName=szhvet, createdTime=Thu Oct 21 01:48:20 CST 2021, time=2021-10-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1061817, encodeId=7b27106181ea3, content=跑过来学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6b042465018, createdName=12426349m50暂无昵称, createdTime=Tue Oct 19 13:33:25 CST 2021, time=2021-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1061809, encodeId=1916106180908, content=可以可以, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210713/ff538698164142c3a7d141196bf907b0/2eaf9277e66a41d493ac6d8a4f84b003.jpg, createdBy=1ba35540722, createdName=胸心外科小医生, createdTime=Tue Oct 19 13:25:47 CST 2021, time=2021-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1061785, encodeId=e4261061e852c, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d642002582, createdName=lgbabe, createdTime=Tue Oct 19 11:57:16 CST 2021, time=2021-10-19, status=1, ipAttribution=)]
    2021-10-19 lgbabe

    不错

    0

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