阳性血培养涂片结果与培养结果不一致的原因探讨  

Reasons for inconsistence in the detection results between Gram-stained direct smear and bacterial cultivation in positive blood cultures

作　　者：卜静雅 马超超[1] 宁安红[2] 王爽[1] 杨茜 杨含草 张聪慧 曹梅琳 郭妍儒 张智洁[3] 赵心宇[1] 

机构地区：[1]大连医科大学检验医学院,辽宁大连116044 [2]大连医科大学基础医学院,辽宁大连116044 [3]中国医科大学附属盛京医院检验科,辽宁沈阳110004

出　　处：《中国微生态学杂志》2017年第12期1452-1455,共4页Chinese Journal of Microecology

摘　　要：目的分析阳性血培养标本,直接涂片结果与培养结果不一致的原因。方法收集一段时间内(2015年8月-2016年12月)送检的血培养标本,进行分析。实验室出现的涂片结果与培养结果不一致的,对其进行分析总结,找到主要原因和需要注意的关键问题。结果符合要求的36 608份标本,血培养阳性报警3 975份,阳性率10.86%,113份涂片结果与阳性培养结果不一致,绝对不一致率为2.84%。55例涂片结果为不确定的标本中,凝固酶阴性葡萄球菌、微球菌、棒状杆菌和α-溶血链球菌共有29例,占52.73%。结论容易误读为阳性球菌的阴性杆菌包括肺炎克雷伯菌、大肠埃希菌、粘质沙雷菌、莫拉菌和鲍曼不动杆菌等。容易误读为阴性杆菌的阳性球菌包括凝固酶阴性葡萄球菌、草绿色链球菌和微球菌。避免将某些阴性杆菌(肺炎克雷伯菌、大肠埃希菌、粘质沙雷菌、莫拉菌和鲍曼不动杆菌等)误读为阳性球菌十分重要。注意革兰染色中脱色步骤的操作,显微镜检查时要注意形态和排列方式不同的阳性细菌。减少危急值的报告错误率,为临床早期诊断与选择抗菌药物治疗,提供准确信息。Objective To analyze the underlying reasons of inconsistence in the detection results between instant direct smear and final cultivation of same blood samples.Methods 36,608 blood samples during August,2015 and September,2016 were collected.Analysis was performed on those with inconsistent results in Gram-stained direct smear and bacterial cultivation to find,the underlying reasons and the key points that need special attention.Results Among the 36,608 samples,3,975（10.86%）ones were labeled positive alarm based on blood culturing.113（2.84%）samples showed inconsistency in the detection results between direct smear and positive cultivation.Among the 55 samples with uncertain results of direct smear,coagulase negative Staphylococci,Micrococci,Corynebacteria andα-hemolytic Streptococci were detected in 29（52.73%）samples.Conclusion Gram negative bacilli that are often mistaken into positive cocci include Klebsiella pneumoniae,Escherichia coli,Serratia marcescens,Moraxellaand Acinetobacter Baumanii etc.,while Gram positive cocci which are often mistaken into negative bacilli include coagulase negative Staphylococci,Viridians streptococci and Micrococci.It is important to avoid such mistakes.The discoloration step in Gram staining,and observation of bacterial morphology should be carried on carefully to reduce error rate of critical values in reports,so as to provide correct and accurate information for early clinical diagnosis and selection of antibacterial drugs.

关 键 词：血培养 危急值 革兰染色法 

分 类 号：R446.5[医药卫生—诊断学]