血培养报阳时间在鉴别血流感染和采血污染中的应用
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李强

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R446.5

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南京军区联勤十八分部医药科技青年培养项目(18FBQN2014007)


Role of time to positivity of blood culture in differentiating bloodstream infection from contamination during blood withdrawal
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    摘要:

    目的分析血培养中不同菌属细菌阳性报警时间在鉴别血流感染(BSI)和采血污染中的意义。方法采用回顾性方法,对2013年11月—2014年11月临床各科住院患者送检的血培养阳性患者临床资料及阳性报警时间进行比较,探讨血培养报阳时间对BSI鉴别诊断的价值。结果2 605份血培养标本,137例血培养阳性,其中病原菌78例(56.93%),污染菌59例(43.07%),污染率最高的是凝固酶阴性葡萄球菌(75.76%),最低的是大肠埃希菌(12.50%)。病原菌组阳性报警时间为(13.86±8.19)h,短于污染组的报阳时间(40.72±20.96)h,两组比较差异有统计学意义(P<0.05)。病原菌组报阳时间最早的是肠球菌(10.20±8.00)h,其次是大肠埃希菌(11.12±3.91)h、金黄色葡萄球菌(12.22±5.08)h、肺炎克雷伯菌(14.72±10.45)h、其他革兰阴性菌(16.11±12.97)h和凝固酶阴性葡萄球菌(16.42±5.74)h,真菌最迟(29.04±3.67)h。革兰阴性菌报阳时间≤16.59 h,BSI的敏感性、特异性分别为84.09%、100.00%;革兰阳性菌报阳时间≤20.96 h,BSI的敏感性、特异性分别为96.77%、94.44%。结论结合血培养阳性报警时间与临床其他指标,对于早期判断检出菌为病原菌或污染菌具有一定的参考价值。

    Abstract:

    ObjectiveTo analyze the significance of time to positivity(TTP) of blood culture in differentiating bloodstream infection(BSI) from contamination during blood withdrawal.MethodsClinical data and TTP of blood culture in patients hospitalized in different departments from November 2013 to November 2014 were compared retrospectively, role of TTP in differential diagnosis of BSI was evaluated.ResultsOf 2 605 blood culture specimens, 137 were positive for blood culture,78(56.93%) of which were pathogenic bacteria and 59(43.07%) were contaminated bacteria, coagulase negative staphylococcus had the highest contamination rate(75.76%),while Escherichia coli had the lowest contamination rate(12.50%). TTP of pathogenic bacteria was shorter than that of contaminated bacteria ([13.86±8.19] h vs [40.72±20.96]h, P<0.05). Of pathogenic bacteria, Enterococcus had the earliest TTP ([10.20±8.00]h),followed by Escherichia coli([11.12±3.91] h), Staphylococcus aureus([12.22±5.08]h), Klebsiella pneumoniae([14.72±10.45] h), the other gramnegative bacteria([16.11±12.97] h),and coagulase negative staphylococci([16.42±5.74] h), fungi had the latest TTP ([29.04±3.67]h ). TTP of gramnegative bacteria was ≤16.59 h, sensitivity and specificity of BSI were 84.09% and 100.00% respectively; TTP of grampositive bacteria was ≤20.96 h, sensitivity and specificity of BSI were 96.77% and 94.44% respectively.ConclusionCombination of TTP of blood culture and other clinical indications can provide reference for early differentiating isolated pathogenic bacteria from contaminated bacteria.

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郭健莲,肖斌龙,刘惠娜,等.血培养报阳时间在鉴别血流感染和采血污染中的应用[J]. 中国感染控制杂志,2015,14(12):803-806. DOI:10.3969/j. issn.1671-9638.2015.12.003.
GUO Jianlian, XIAO Binlong, LIU Huina, et al. Role of time to positivity of blood culture in differentiating bloodstream infection from contamination during blood withdrawal[J]. Chin J Infect Control, 2015,14(12):803-806. DOI:10.3969/j. issn.1671-9638.2015.12.003.

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  • 收稿日期:2015-05-10
  • 最后修改日期:2015-09-16
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  • 在线发布日期: 2015-12-30
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