血培养阳性标本直接快速药敏试验临床应用价值评估  

Evaluation of clinical application value of rapid antimicrobial susceptibility test on positive blood culture specimens

作　　者：张渝琴 罗福康 周丽[1] 阮真 朱星辉 汪曼菲 ZHANG Yuqin;LUO Fukang;ZHOU Li;RUAN Zhen;ZHU Xinghui;WANG Manfei(Department of Laboratory Medicine,Chongqing Ninth People′s Hospital,Chongqing 400700,China)

机构地区：[1]重庆市第九人民医院检验科,重庆400700

出　　处：《检验医学与临床》2023年第21期3132-3139,3143,共9页Laboratory Medicine and Clinic

摘　　要：目的通过比对血培养阳性标本直接快速药敏试验(RAST)与常规药敏试验结果的符合(CA)比例,探讨血培养RAST的临床应用价值。方法收集2021年4月至2022年4月重庆市第九人民医院血培养阳性标本,革兰阴性杆菌参考欧洲药敏试验委员会(EUCAST)发布的纸片法血培养阳性瓶进行RAST,革兰阳性球菌参考CLSI 2021 M100对血培养阳性标本进行RAST,并将结果与常规药敏试验结果进行比对。结果409例血培养阳性标本中分离培养出大肠埃希菌178株、肺炎克雷伯菌62株、铜绿假单胞菌8株、葡萄球菌100株和肺炎链球菌7株。RAST结果与常规药敏结果相比:肠杆菌在4、6、8 h CA比例分别为78.8%、90.5%、91.5%,6 h药敏结果CA比例优于4 h(P<0.05),但与8 h比较差异无统计学意义(P>0.05)。铜绿假单胞菌在6、8 h CA比例分别为80.4%、92.9%。葡萄球菌在16 h CA比例为90.7%。肺炎链球菌在20~24 h CA比例为100.0%。肠杆菌CA比例最高的药物为庆大霉素,错误率为0的药物为美罗培南,严重错误率最高的为环丙沙星;葡萄球菌CA比例最高的药物为青霉素和利奈唑胺,均为100.0%,克林霉素微小错误率较高,为21.0%。结论血培养RAST能够快速、准确地为临床提供初步药敏结果,指导临床目标性抗感染治疗。Objective To evaluate the clinical application value of rapid antimicrobial susceptibility testing(RAST)by comparing the categorial agreement(CA)of results of rapid antimicrobial susceptibility test with routine susceptibility test of positive blood culture.Methods Positive blood culture specimens in the Chongqing Ninth People,s Hospital were collected from April 2021 to April 2022.The RAST of Gram-negative bacilli to positive blood culture was referred to slip method issued by European Committee on Antimicrobial Susceptibility Testing(EUCAST),the RAST of Gram-positive cocci to positive blood culture was referred to Clinical and Laboratory Standards Institute(CLSI)2021 M100,and the results were compared with routine susceptibility test.Results A total of 178 strains of Escherichia coli,62 strains of Klebsiella pneumoniae,8 strains of Pseudomonas aeruginosa,100 strains of staphylococcus and 7 strains of Sresptococcus pneumoniae were isolated and cultured from 409 positive blood culture specimens.Compared to conventional drug sensitization results,the RAST results showed that the CA proportions in Enterobacteriaceae were 78.8%,90.5%,91.5%at 4,6 and 8 hours,respectively;the average CA proportions of antimicrobial susceptibility results at 6 hours was better than those of 4 hours(P<0.05),but there was no statistical difference of these results between 6 hours and 8 hours(P>0.05).The CA proportions in Pseudomonas aeruginosa were 80.4%,92.9%at 6 and 8 hours,respectively.The CA proportion in staphylococcus was 90.7%at 16 hours.The CA proportions in Sresptococcus pneumoniae were all 100.0%from 20 hours to 24 hours.The antimicrobial agent with the highest CA proportion in Enterobacteriaceae was gentamicin,error rate to meropenem was zero,and the highest proportion of very major errors was ciprofloxacin.The antimicrobial agent with the highest CA proportion in staphylococcus was penicillin and linezolid,both were 100.0%,and the highest minor errors occurred in clindamycin with 21.0%.Conclusion RAST can provide rapid and ac

关 键 词：血培养 直接快速药敏试验 临床应用 

分 类 号：R446[医药卫生—诊断学]