血培养阳性报警时间对临床病原菌鉴别的探讨  

Significance of time to positivity in blood culture for the identification of clinical pathogenic bacteria

作　　者：王敏[1] 许顺姬[1] 金春梅[1] 石蓉[1] 宋晓旭[1] 

机构地区：[1]延边大学附属医院检验科,吉林延吉133000

出　　处：《中华医院感染学杂志》2017年第3期528-531,共4页Chinese Journal of Nosocomiology

摘　　要：目的探讨血培养的阳性报警时间(TTP)用于鉴别病原菌与污染菌的临床意义和导管相关性血流感染的辅助诊断。方法收集2009年1月-2014年12月医院病原微生物室检查的门诊、急诊及住院患者标本17 871份,分析其阳性报警时间对病原菌与污染菌的临床鉴别的应用,根据外周血培养时间差(DTTP)辅助诊断导管相关性血流感染。结果 17 871份培养瓶中,血培养阳性标本1 585份,需氧瓶和厌氧瓶同时阳性的标本769份(48.5%),仅需氧瓶报阳性的标本501份(31.6%),仅厌氧瓶报阳性的标本315份(19.9%);报阳性瓶数共2 354瓶,共检出2 516菌株,阳性率14.1%,其中分离一种菌株为2195瓶(93.2%)、分离两种菌株为156瓶(6.6%)、分离三种菌株为3瓶(0.2%),在2 354报阳性瓶中平均TTP为17.4h;1 270个需氧瓶(54.0%)平均TTP为18.7h,1 084个厌氧瓶(46.0%)平均TTP为15.8h,需氧瓶与厌氧瓶TTP差异有统计学意义(P<0.001);金黄色葡萄球菌平均TTP为18.8h最短,而表皮葡萄球菌TTP 25.6h、凝固酶阴性葡萄球菌TTP 29.3h,TTP时间的延长怀疑污染菌的可能性增加;外周血和导管血同时培养的172例标本,其中DTP>2h54份(31.4%),36株金黄色葡萄球菌中DTP>2h的10株(27.8%),36株表皮葡萄球菌DTP>2h的26株(72.2%),阴沟肠杆菌、粪肠球菌、屎肠球菌DTP大部分均在2h内,1例DTP>2h。结论结合临床资料和TTP可以初步鉴别病原菌与污染菌;DTTP>2h可以辅助诊断导管相关性血流感染。OBJECTIVE To investigate the clinical significance of time to positivity（TTP）in blood culture for the identification of pathogenic bacteria and contaminated bacteria and auxiliary diagnosis of catheter-related bloodstream infection.METHODSl.A total of 17871 samples of outpatient,emergency and inpatient examined in the laboratory of pathogenic microorganism of Yanbian Hospita from Jan.2009 to Dec.2014 were collected.Using chi-square test and t-test,the application of TTP in the clinical identification of pathogenic bacteria and contaminated bacteria were analyzed.Catheter related blood stream infections were diagnosed by using DTTP.RESULTS Totally 1585 positive samples were collected from 17871 cases of culture bottles,including 769cases（48.5%）of both aerobic and anaerobic positive bottles,501cases（31.6%）of aerobic positive bottles,and 315cases（19.9%）of anaerobic positive bottles.The number of positive bottles was 2 354,and 2 518 strains of bacteria were detected,with the positive rate of 14.1%,including 2185（93.2%）bottles of 1strain of bacteria,156（6.6%）bottles of 2strains of bacteria,and 3（0.2%）bottles of 3strains of bacteria.The average TTP of 2 354 positive bottles was 17.4h,of 1 270（54.0%）aerobic bottles was 18.7h,and of 1 084（46.0%）anaerobic bottles was 15.8h,and there was significant difference in TTP between the aerobic and anaerobic bottles（P〈0.001）.The average TTP of Staphylococcus aureus（18.8h）was the shortest,Staphylococcus epidermidis was 25.6h,coagulase negative Staphylococcus was 29.3h,and prolonged TTP tine increased the possibility of suspected contamination bacteria.In 172 specimens of simultaneously cultured peripheral blood and catheter blood,there were 54 cases of DTP〉2h（31.4%）;in 36 strains of Staphylococcus aureus,there were 10 cases of DTP〉2h（27.8%）;and in 36 strains of Staphylococcus epidermidis,there were 26 cases of DTP〉2h（72.2%）.The most of DTP of Enterobacter cloacae,Enterococcus faecalis,Enterococcus faecium were less tha

关 键 词：血培养的阳性报警时间 导管相关性感染 病原菌 污染菌 

分 类 号：R378[医药卫生—病原生物学]