目的 研究念珠菌血症血培养报阳时间(time to positivity,TTP)对念珠菌菌种鉴别的价值.方法 收集南京鼓楼医院2018年1月至2023年3月罹患念珠菌血症患者190例,回顾性分析患者基本信息及分离真菌菌种分布;对不同念珠菌的TTP进行统计学分析,并对热带念珠菌和光滑念珠菌的TTP进行受试者曲线分析.结果 190例念珠菌血症患者中60岁以上占62.11％,男性占比高于女性,患者主要分布在重症监护室、心胸外科、普通外科、急诊.190份血液样本共检出白念珠菌79株、热带念珠菌37株、近平滑念珠菌34株、光滑念珠菌26株和其他念珠菌14株.各真菌TTP分别为白念珠菌(35.02±15.92)h、热带念珠菌(17.97±6.09)h、近平滑念珠菌(31.06±10.68)h、光滑念珠菌(56.70±24.92)h;其中,热带念珠菌的TTP＜其他念珠菌,差异具有统计学意义(P＜0.05);光滑念珠菌的TTP＞其他念珠菌,差异具有统计学意义(P＜0.0001).受试者工作曲线显示,热带念珠菌曲线下面积0.9007,95％置信区间(0.8502～0.9513),cut-off值≤23.76 h时的灵敏度为94.59％,特异度为82.35％,阴性预测值和阳性预测值分别为98.44％和56.45％;光滑念珠菌曲线下面积0.8131,95％置信区间(0.7184～0.9078),cut-off值≥46.27 h时的灵敏度为61.54％,特异度为91.46％,阴性预测值和阳性预测值分别为93.75％和53.32％.结论 念珠菌血症患者中热带念珠菌TTP＜其他念珠菌,光滑念珠菌TTP＞其他念珠菌,有助于热带念珠菌、光滑念珠菌与其他念珠菌的早期鉴别.
Retrospective analysis of time to positive of 190 cases with candidiemia
Objective To research the significance of time to positive of blood culture for early identification of candidemia.Methods A retrospective study of 190 samples of candidemia from Nanjing Drum Tower Hospital from January 2018 to March 2023 were applied to explore the role of TTP in C.tropical and C.glabrata.We used Student's t-test to analyse the TTP among different Candida species.The diagnostic values and cut-off values of the TTP for C.tropicalis and C.gla-brata were evaluated by the receiver operating characteristic(ROC)curve.Results The mean TTP of C.albican s(n=79),C.glabrata(n=26),C.parapsilosis(n=34)and C.tropicalis(n=37)(35.02±15.92)h,(56.70±24.92)h,(31.06±10.68)h,and(17.97±6.09)h respectively.The TTP of C.tropicalis shorter than other Candida species(P＜0.05).The TTP of C.glabrata longer than other Candida species(P＜0.0001).The area under the receiver operating characteristics(AUC)curve of C.tropicalis 0.9007 with a sensitivity of 94.59％,a specificity of 82.35％,a negative predictive value of 98.44％and a positive predictive value of 56.45％respectively,indicating TTP with a cut-off value of ≤23.76 h.The AUC curve of C.glabrata 0.8131 with a sensitivity of 61.54％and a specificity of 91.46％,a negative predictive value of 93.75％and a positive predictive value of 53.32％respectively,indicating TTP with a cut-off value of ≥46.27 h.Conclu-sions The TTP of C.tropicalis shorter than other Candida species.The TTP of C.glabrata longer than other Candida species.TTP be used for the early identification of C.tropicalis and C.glabrata in patients with candidemia.
candidemiatime to positivityC.tropicalisC.glabrata
万方数据
维普
