| Objective:Bloodstream infection is a disease with a high morbidity and mortality rate.In this study,we retrospectively analyzed the symptoms and signs of patients with bloodstream infection(BSI),collected microbiological and drug sensitivity test data,combined with the four diagnostic information of Chinese medicine(TCM),and identified the elements of TCM symptoms to understand the composition,distribution and drug resistance of BSI in our hospital(Affiliated Hospital of Shandong University of Chinese Medicine).The study also analyzed the relationship between the distribution pattern of TCM symptoms and the composition and drug resistance of pathogenic bacteria,and provided a basis for TCM intervention.Methods:Retrospective analysis of patients who were admitted to the Affiliated Hospital of Shandong University of Traditional Chinese Medicine and diagnosed with blood stream infection from November 2020 to January 2022.Relevant clinical data of BSI patients were collected,including name,hospitalization number,age,gender,hospitalization department,underlying disease,admission diagnosis,relevant treatment measures before the occurrence of BSI(more than 7 days of hormones,immunosuppressants,insulin use,blood product use,surgery,mechanical ventilation,renal replacement therapy,parenteral nutrition,Chinese medicine treatment)and other invasive operations,site of infection,statistics of patients’ blood We also collected the white blood cell count,haemoglobin,calcitoninogen,platelets,bilirubin,glomerular filtration rate,urea nitrogen and other test indicators within 3 days of positive blood culture;at the same time,according to the electronic medical records,we recorded the information of the four Chinese medicine consultations on the first,third and seventh days of positive blood culture sampling to identify the Chinese medicine symptoms,and then analysed the relationship between the Chinese medicine symptoms and The relationship between the TCM symptoms and pathogenic bacteria and drug resistance was analysed.The data was processed using SPSS26.0 software.The data were expressed as mean±standard deviation for those measures that conformed to normal distribution and median(quartiles)for those that did not conform to normal distribution,and frequency and percentage(n,%)were used for counting data.For comparison between two groups,t-test or rank sum test was performed according to whether the variance was homogeneous,and P<0.05 indicated that the difference was statistically significant.For comparison between multiple groups,one-way ANOVA or Welch’s ANOVA was performed according to the homogeneity of the variance.Results:A total of 226 patients with BSI were collected in this study,including 139 male patients(61.5%)and 87 female patients(38.5%).The mean age was 68.13±20.78,and the highest frequency of patient age was 85 years.Patients with BSI occurred mainly in people over 60 years of age,with the highest number of patients aged 75-90 years,accounting for35.40%.The top six departments with the highest number of BSIs in our hospital were intensive care medicine(45 cases,19.9%),health care(38 cases,16.8%),hematology(32cases,14.2%),splenomegaly(13 cases,5.8%),oncology(11 cases,4.9%)and cardiology(9 cases,4.0%),in that order.The most common underlying disease in the study patients was hypertension(107 cases,47.3%).Other underlying diseases included chronic bronchitis,chronic obstructive pulmonary disease,diabetes mellitus,coronary heart disease,hypoproteinemia,electrolyte disorders,tumours,bronchial asthma,cardiac insufficiency,bronchiectasis,renal insufficiency,interstitial pulmonary fibrosis and hepatic insufficiency.Of the 226 patients,153 had invasive procedures(most commonly arteriovenous tube puncture placement)prior to positive blood cultures during hospitalisation;all patients were treated with a combination of Chinese and Western medicine,and 167 patients were treated with Chinese medicine in addition to herbs during hospitalisation.The most common site of infection in all patients was the respiratory system(132 patients,55.2%),with the others in order being the urinary system,digestive system,other,catheter-associated bloodstream infection,primary bloodstream infection,skin/soft tissue,and central nervous system.There were 236 pathogenic strains that met the inclusion criteria,including 232 bacterial strains(98.3%)and 4 fungal strains(1.7%).Gram-negative bacteria(G-bacteria)accounted for 132 strains(55.9%)of the bacteria.Gram-positive bacteria(G+ bacteria)were 100 strains,accounting for 42.4%.The top 5 bacteria in terms of composition were Escherichia coli(23.3%),Klebsiella pneumonia subspecies(14.8%),Staphylococcus aureus(8.5%),human staphylococcal subspecies(7.6%),and Pseudomonas aeruginosa(6.8%).There were three species of fungi,in descending order of composition:Pseudomonas Albicans(0.8%),Pseudomonas smooths(0.4%),and Pseudomonas syringae(0.4%).Among them,there were 63 strains(26.7%)of multi-resistant bacteria and 9strains(3.8%)of pan-resistant bacteria.Inflammatory indicators(especially PCT)were higher than normal in patients with BSI,while other indicators were not significantly abnormal.Among the 226 patients in this study,a total of 463 cases involved in the positive blood culture on the first day of sampling.The BSI was classified into deficiency,solid and mixed evidence by the identification of deficiency and solid.55 cases(24.6%)were classified as deficiency,100 cases(44.2%)were classified as solid and 71 cases(31.4%)were classified as mixed;70 cases(31.0%)were classified as deficiency,68 cases(30.1%)were classified as solid and 88 cases(38.9%)were classified as mixed;77 cases(34.1%)were classified as deficiency and 44 cases(38.9%)were classified as solid.38.9%;77cases(34.1%)with deficiency evidence,44 cases(19.5%)with actual evidence and 105cases(46.5%)with mixed deficiency and actual evidence on day 7 of positive blood culture sampling.The symptoms involved on the first day of positive blood culture were,in descending order of frequency,Qi deficiency(92 cases),solid heat(81 cases),blood stasis(81 cases),phlegm(63 cases),Yin deficiency(54 cases),blood deficiency(41cases),water retention(37 cases)and Yang deficiency(14 cases).In the analysis of the evidence of deficiency and reality on day 1 of positive blood culture sampling in BSI patients with G+,G-and fungal infections,all three groups of patients were most commonly found to have actual evidence,followed by deficiency evidence,and the least amount of mixed evidence of deficiency and reality.The most common evidence of deficiency was qi deficiency and yin deficiency,while the most common evidence of actual heat and blood stasis.There was no significant difference in pathogenic species in terms of deficiency identification and TCM symptoms.In the comparison of the laboratory indices of the three groups,calcitoninogen level: deficiency group > actual group > mixed group;haemoglobin level: actual group > mixed group > deficiency group;platelet count:actual group > mixed group > deficiency group(P<0.05).Conclusion:1.BSI mostly occurred in elderly people aged 75-90,with more males than females;the most common underlying disease among the 226 BSI patients was hypertension,the common onset departments were ICU and health care units,invasive operations were a high incidence factor for BSI patients,and the most common site of infection was the respiratory system.2.Among the pathogens of BSI in our hospital,the proportion of G-bacteria was slightly higher than that of G+ bacteria;G-bacteria were mainly Escherichia coli,followed by Klebsiella pneumonia,Pseudomonas aeruginosa and Acinetobacter baumannii;The top three G+ bacteria were Staphylococcus aureus,Staphylococcus aureus subspecies,and Staphylococcus epidermidis.The top three resistant bacteria were Escherichia coli,Klebsiella pneumoniae subspecies and Pseudomonas aeruginosa.3.The distribution of symptoms in Chinese medicine: in the early stage of BSI,the main symptoms are actual symptoms(in the case of actual symptoms,actual heat and blood stasis),in the middle stage,the main symptoms are mixed symptoms of deficiency and reality,and in the late stage,the main symptoms are mixed symptoms of deficiency and reality and deficiency.Among the specific symptoms,qi deficiency and actual heat are more common in BSI patients,and most of them are characterized by "deficiency at the root and actual at the symptoms".There was no significant difference in pathogenic species in terms of deficiency identification and TCM symptoms on day 1 of positive blood culture sampling.On the first day of positive blood culture sampling,the inflammation indexes and routine blood indexes of patients with different symptoms of deficiency and actuality were compared,calcitoninogen level: deficiency group > actuality group > mixed deficiency group;haemoglobin level: actuality group > mixed deficiency group > deficiency group;platelet count: actuality group > mixed deficiency group >deficiency group. |
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