重庆某三甲医院血培养阳性的特征分析  

Analysis on characteristics of blood culture positive in a class 3A hospital of Chongqing

作　　者：阮真 毛隆春 费凌 李志强 张小琴 胡娟 许商成 王维 RUAN Zhen;MAO Longchun;FEI Ling;LI Zhiqiang;ZHANG Xiaoqin;HU Juan;XU Shangcheng;WANG Wei(Department of Clinical Laboratory,Chongqing Municipal Ninth People′s Hospital,Chongqing 400799,China;Experimental Medicine Center,First Affiliated Hospital of Chongqing Medical and Pharmaceutical College,Chongqing 400060,China)

机构地区：[1]重庆市第九人民医院检验科,重庆400799 [2]重庆医药高等专科学校附属第一医院实验医学中心,重庆400060

出　　处：《检验医学与临床》2024年第6期793-799,共7页Laboratory Medicine and Clinic

基　　金：重庆市2022年科卫联合医学科研面上项目(2022MSXM148)。

摘　　要：目的对血培养报阳标本检出微生物种类、报阳时间、感染与污染、送检前用药情况、新型冠状病毒感染(COVID-19)等特征进行分析,探讨血培养报阳相关特征在血流感染诊断中的应用价值。方法采用回顾性研究方法,收集重庆医药高等专科学校附属第一医院2021年1月至2023年1月住院部1856例患者送检的血培养标本相关特征并进行分析。结果2021年1月至2023年1月共送检血培养标本7042瓶,其中6389瓶(90.73%)为阴性,653瓶(9.27%)为阳性。共检出691株病原菌,其中128株(18.52%)病原菌为仅需氧瓶报阳,57株(8.25%)为仅厌氧瓶报阳;549株(79.45%)病原菌为感染菌,109株(15.77%)病原菌为污染菌,33株(4.78%)病原菌临床意义未知,检出菌中革兰阴性菌污染率小于革兰阳性菌。大部分病原菌报阳时间在20 h以内,大肠埃希菌和凝固酶阴性葡萄球菌感染血培养报阳时间均短于污染(P<0.05)。分别将报阳时间21.96 h和18.12 h作为区分血培养阳性瓶中检出的大肠埃希菌和凝固酶阴性葡萄球菌污染与感染的最佳时间点,曲线下面积分别为0.95和0.88。抗微生物药物治疗前送检的血培养真阳性率高于抗微生物药物治疗后送检(P<0.05),且急性呼吸综合征冠状病毒2(SARS-CoV-2)阳性来源的血培养真阳性率明显低于SARS-CoV-2阴性来源的血培养(P<0.001)。结论血流感染病原菌多数需氧瓶和厌氧瓶同时报阳,血培养阳性检出菌中革兰阴性菌污染率小于革兰阳性菌,且阳性报警时间可作为鉴别分离菌污染与感染的重要指标。Objective To analyze the characteristics of detected microbial species,reported positive time,infection and contamination,medication before submitted detection and COVID-19 infection in positive specimen of blood cultures,and to investigate the application value of characteristics related to blood culture reported positive in the diagnosis of bloodstream infection.Methods The retrospective study method was adopted.The characteristics related blood culture samples submitted by 1 856 patients in the Inpatient Department of the First Affiliated Hospital of Chongqing Medical and Pharmaceutical College from January 2021 to January 2023 were collected and analyzed.Results A total of 7 042 bottles of blood culture samples were submitted in the whole hospital from January 2021 to January 2023,in which 6 389 bottles(90.73%) were negative,while 653 bottles(9.27%) were positive.A total of 691 strains of pathogenic bacteria were detected,in which 128 strains(18.52%) were the aerobic bottle reported positive and 57 strains(8.25%) were the anaerobic bottles reported positive.A total of 549 strains(79.45%) were the pathogenic bacteria,109 strains(15.77%) were the contaminant bacteria and 33 strains(4.78%) were the unknown clinical significance.In the detected bacteria,the contamination rate of Gram-negative bacteria was less than that of Gram-positive bacteria.Most of the pathogenic bacteria reported positive time was within 20 h.The blood culture reported positive time of Escherichia coli and coagulase-negative Staphylococcus strains was shorter than that of the contaminated bacteria(P<0.05).The reported positive time of 21.96 h and 18.12 h served as the optimal time points respectively,which distinguishing contamination and infection of Escherichia coli and coagulase negative Staphylococcus detected in blood culture positive bottles,the areas under the curves were 0.95 and 0.88 respectively.The true positive rate of blood culture prior to antimicrobial drug treatment was higher than that after antimicrobial medication treatme

关 键 词：血培养 病原菌 污染菌 报阳时间 血流感染 

分 类 号：R446.5[医药卫生—诊断学]