血培养的菌群分布特点及阳性报警时间在临床早期用药的提示意义

The Implications of Bacterial Flora Distribution Characteristic of the Blood Culture and Positive Alarm Time in the Early Clinical Medication

目的：分析血培养的菌群分布特点及阳性报警时间在鉴别致病菌和污染菌的意义,协助临床医生早期合理用药提供实验室诊断依据。方法：回顾性分析本院2012-2013年的8291份血培养标本的阳性菌群分布情况,并对细菌的阳性报警时间进行分析。结果：8291份血培养标本中,阳性报警971例,其中转种分离出细菌的比例占为10.3%（854/8291）,无菌生长假阳性的比例占12.0%（117/971）,镜检阳性而培养阴性的比例占10.2%（12/117）;854株细菌中革兰阴性杆菌126株（14.8%）,革兰阳性球菌696株（81.5%）,真菌32株（3.7%）;〈18 h检出308株（36.1%）,19～24 h检出224株（26.2%）,25～47 h检出189株（22.1%）,〉48 h检出133株（15.6%）;假阴性株14株（2.8%）,其中真菌8株,阳性球菌5株,粘质沙雷1株。结论：菌群分布特点及阳性报警时间有助于区别致病菌和污染菌,可以尽早让临床医生结合患者资料综合作出科学判断,为抗生素的早期、合理选择使用提供实验室诊断依据。

Objective：To analyze the significance of the bacterial flora distribution characteristic of the blood culture and positive alarm time in pathogenic bacteria and contaminating bacteria identification,in order to assist clinicians provide laboratory diagnosis basis for early the rational use of drugs.Method：8291 specimens of blood culture from 2012 to 2013 in our hospital were selected retrospectively,and its positive bacterial flora distribution and the bacterial positive alarm time were analyzed.Result：In 8291 specimens of blood culture had 971 cases of positive alarm, switched to 854 strains of isolate bacteria cultivation（10.3%）,117 strains of sterile false positive growth（12.0%）, microscopy positive but culture negative had 12 strains（10.2%）.In 854 strains,126 strains（14.8%） were bacteria gram negative bacilli,696 strains（81.5%） were gram positive coccus,32 strains（3.7%） were fungus, 18 h detected 308 strains（36.1%）,19-24 h detected 224 strains（26.2%）,25-47 h detected 189 strains（22.1%）, 48 h detected 133 strains（15.6%）.False negative strains had 14 strains（2.8%）,included 8 strains of fungi,5 strains of positive coccus,1 strain of serratia marcescens.Conclusion：The bacterial flora distribution characteristics and positive alarm time are helpful to distinguish between pathogenic bacteria and contaminating bacteria, can enable clinicians as early as possible combined with patient data to make a comprehensive scientific judgment, the reasonable choice of antibiotics use provide laboratory diagnosis basis.