Abstract:

Objective To investigate the risk factors of CRE infection and the value of neutrophil-to-lymphocyte ratio(NLR), procalcitonin(PCT), monocyte chemo-attractant protein-1(MCP-1) in the differential diagnosis of infection in critically ill patients undergoing neurosurgery.

Methods In total, 122 patients with severe infection in Department of Neurosurgery of our hospital were selected as the research subjects, including 61 cases of carbapenem-resistant Enterobacteriaceae(CRE) infections and 61 cases of carbapenem-sensitive Enterobacteriaceae(CSE) infections. The clinical data, NLR, PCT, MCP-1 of the two groups were compared, and the risk factors of CRE infection were analyzed by Logistic regression. Pearson analysis was used to analyze the correlation between NLR, PCT, MCP-1 and acute physiology and chronic health(APACHEⅡ) score, and ROC was used to analyze the differential diagnosis value of NLR, PCT, and MCP-1 in critically ill patients with CRE infection undergoing neurosurgery. KM curve was used to analyze the survival rate of NLR, PCT, MCP-1 high-level group and low-level group.

Results There was a statistically significant difference between two groups with respect to antibiotic drug application, duration of antibiotic drug use, carbapenem use, APACHEⅡ score, NLR, PCT and MCP-1 levels(P＜0.05). The use of antibiotics ≥ 2 combinations, the duration of antibiotics use ≥ 10 days, the use of carbapenems, the APACHE Ⅱ score≥20, NLR, PCT, and MCP-1 high-level expression were all risk factors for CRE infection in critically ill patients undergoing neurosurgery(P＜0.05). There was a positive correlation between NLR, PCT, MCP-1 and APACHEⅡ score in patients with severe CRE infection undergoing neurosurgery(P＜0.05). AUC value of combined diagnosis of CRE infection was greater than single diagnosis(P＜0.05). The mortality of patients with high levels of NLR, PCT and MCP-1 in CRE infection was higher than that in the low-level group(P＜0.05).

Conclusion CRE infection in critically ill patients undergoing neurosurgery is affected by multiple factors. Among them, NLR, PCT, and MCP-1 are closely related to the severity of the disease, which is conductive to the differential diagnosis of CRE infection. Therefore, targeted intervention measures can be taken accordingly to prevent the occurrence of CRE infection.

Key words: enterobacteriaceae infection, procalcitonin, chemokine CCL2