Analysis Of Pathogens Of Infection In Patients With Agranulocytosis Of Acute Leukemiaand The Guidance Of PCT、CRP、ESR For Pathogens

Objective:Analysis of species and distribution for pathogens of infection in patients with agranulocytosis of acute leukemia（AL）,and to explore the vaule of procalcitonin（PCT）、C-reactive protein（CRP）、erythrocyte sedimentation Rate（ESR）in those patients,to guide clinicians using antibiotics and reducing mortality of infection.Methods:1.A total of 202 AL patients with agranulocytosis who were treated in Hebei General Hospital from 2017.09 to 2020.10 were assigned as the study group,to retrospective analysis of infection rate、the species and distribution for pathogens of infection;2.According to the result of infection,the pathogens could be categorized into three groups（gram-negative bacteria,gram-positive bacteria and fungus groups）,to observe the variation tendency of PCT、CRP、ESR in three groups;3.The statistical software SPSS 23.0 was used to make statistics and analyze the data results,the difference was statistical significance in P<0.05.Results:1.Total 138（median age was 60,56 cases of male,83 cases of female）episodes of infections occurred in 202 AL patients with agranulocytosis（median age was 45,81 cases of male,121 cases of female）.2.Gram-negative bacteria was 65.99%,which consists largely of pseudomonas alcaligenes（13.61%）;Gram-positive bacteria was 25.17%,which was primarily clostridium difficile（5.44%）;Fungus was 8.84%,in stands dominated by candida albicans.3.The distribution for pathogens of infection:pulmonary was 21.09%,which consists largely of klebsiella pneumoniae;Bloodstream was 9.52%,which was primarily staphylococcus aureus;Upper respiratory was 8.16%,in stands dominated by klebsiella pneumoniae;Digestive system was 4.08%,which consists largely of Stenotrophomonas maltophilia;Skin and mucosa was 25.17%,which was primarily staphylococcus aureus and candida albicans;patients fell ill from unknown infection was 54.42%.4.Inflammatory cytokine:（1）PCT:There was a statistical difference between gram-negative bacteria and gram-positive bacteria group（P<0.05）,each of two was no difference from fungus group（P>0.05）;（2）CRP:There was a statistical significance between gram-negative bacteria、gram-positive bacteria to fungus groups（P<0.05）,and there was no statistical significance in gram-negative bacteria and gram-positive bacteria group（P>0.05）;（3）ESR:There was no statistical significance in any two groups（P>0.05）;（4）Take PCT≥0.05ng/ml、CRP≥10mg/l、ESR≥20mm/h as positive incidence,which has no statistical difference in the three groups（P>0.05）.5.The receiver operating characteristic（ROC）curve of PCT、CRP、ESR to identify three pathogens of infection:（1）PCT alone had detected about the difference between gram-negative bacteria and gram-positive bacteria,AUC_pct=0.665, sensitivity was 80.6%and specificity was 47.4%;（2）It can compare to the difference between gram-negative bacteria and gram-positive bacteria,to use three inflammatory cytokines together:AUC_pct+crp+esr=0.67,sensitivity was 77.8%and specificity was 57.7%;（3）CRP alone had detected about the difference between gram-negative bacteria and fungus,AUC_crp=0.684,sensitivity was 84.6%and specificity was 52.6%;（4）It can improved specificity of the difference between gram-negative bacteria and fungus,to use three inflammatory cytokines together:AUC_pct+crp+esr=0.761,sensitivity was 84.6%and specificity was 66%;（5）CRP alone had detected about the difference between gram-positive bacteria and fungus,AUC_crp=0.694, sensitivity was 76.9%and specificity was 63.9%;（6）It can improved sensitivity of the difference between gram-positive bacteria and fungus,to use three inflammatory cytokines together:sensitivity was 97.9%and specificity was 44.4%,but reducing specificity.Conclusion:1.Gram-negative bacteria were the most common pathogens in granulocyte lack infected patients,and pulmonary infection was the most common distribution of pathogens;2.The detection of serum PCT、CRP and ESR is of great significance for discernment in the species of pathogens,and the positive rate of which have no statistical difference;3.The concentrations of PCT、CRP and ESR used together could provide more sensitivity and specificity for the early diagnosis of infection.