凝固酶阴性葡萄球菌在血培养阳性结果中的临床价值  

Clinical value of positive coagulase negative Staphylococci in blood culture

作　　者：曹春来[1] 陈益明[1] 徐立冬[1] 

机构地区：[1]杭州市余杭区妇幼保健院,浙江杭州311100

出　　处：《中国微生态学杂志》2014年第8期931-934,共4页Chinese Journal of Microecology

摘　　要：目的通过对凝固酶阴性葡萄球菌(CNS)在血培养阳性结果中的检出情况研究,探讨血标本中CNS阳性的临床价值。方法回顾性分析2011年3月至2013年3月,杭州市余杭区妇幼保健院血液细菌培养阳性标本中50例成人患者和50例幼儿患者的感染情况,以及送检血液培养标本中分离到CNS结果及耐药性分析。采用法国梅里埃Bact/ALERT 3D(120)血培养仪对临床送检血培养标本进行培养,应用美国BD Phoenix 100全自动细菌鉴定药敏分析仪完成细菌鉴定及药敏分析。结果在分离到的100株CNS菌株中共检出病原菌的CNS 73株,污染菌的CNS 27株。其中,50例成人血培养标本中检测CNS阳性患者中,菌血症有28例(56.0%),污染菌有22例(44.0%);50例幼儿患者血培养中,菌血症有45例(90.0%),污染菌有5例(10.0%)。CNS感染的成人和幼儿菌血症患者对抗菌药物的耐药性比较,除庆大霉素、新生霉素和替考拉宁外,其余抗生素均发现差异有统计学意义(P<0.05)。提高苯唑西林的给药剂量有利于减少细菌的耐药性,但差异无统计学意义(P>0.05)。病原菌与污染菌各抗菌药物耐药性之间比较,差异均无统计学意义(P>0.05)。提高苯唑西林的剂量可减少细菌的耐药性,但差异无统计学意义(P>0.05)。在短期血标本中(≤48 h),既能检测到病原菌又能检测到污染菌,而在长期血标本中(>48 h),仅能检测到污染菌。此外,病原菌的检测时间明显短于污染菌的检测时间(P<0.05)。结论鉴于CNS菌血症样本的污染率较高,对血培养CNS阳性结果不能作为确诊结果,应结合临床资料和实验室结果,综合考虑以判定是否为致病菌,有利于临床科学合理的使用抗菌药物,减少药物耐药性的发生,减轻患者的医疗费用。Objective To explore the clinical value of positive coagulase negative Staphylococcus（CNS） in blood cultures. Methods 50 cases of adult patients and 50 cases of infant patients with positive blood culture results were retrospectively analyzed. The BioMerienx Bact /ALERT 3D（120） blood culture system was used for culture of the specimens,and the bacterial identification and drug susceptibility analysis was completed using U. S. BD Phoenix100 automatic bacterial identification and susceptibility system. Results In the total 100 strains of CNS isolated,73 of CNS pathogens and 27 of CNS contaminants were detected. Among the 50 adult patients with positive CNS results,28 cases were with bacteremia（56. 0%） and 22 with contaminants（44. 0%）; among the 50 infant patients,45 cases were with bacteremia（90. 0%）,and 5 cases with contaminants（10. 0%）. The drug resistances in between adult and infant patients with bacteremia secondary to CNS infections were found statistically different except to gentamicin,novobiocin and teicoplanin（P〈0. 05）. Increased dose of oxacillin contributed to reducing bacterial resistance,but the difference was not statistically significant（ P〉0. 05）. The resistances of pathogens and contaminants to antibacterial agents showed no statistically significant difference（P〈0. 05）; Increased dose of oxacillin contributed to reducing bacterial resistance, but the difference was not statistically significant（P〈0.05）. Both pathogens and contaminants were detected in short-term blood specimens（≤48 h）,while only contaminants were detected in the long-term blood specimens（ 48 h）. In addition,the detection time of pathogens was significantly shorter than that of contaminants（ P〈0. 05）. Conclusion Giving the high contamination rate of CNS bacteremia specimens,the CNS-positive results from blood culture cannot be used as the diagnosis,and a comprehensive consideration of clinical data and laboratory results should be made to determine whether they are pa

关 键 词：凝固酶阴性葡萄球菌 血培养 病原菌 菌血症 

分 类 号：S853.1[农业科学—临床兽医学]