需氧与厌氧配对培养在血流感染诊断中的价值

Diagnostic advantage of paired aerobic and anaerobic cultures for blood stream infection

目的探讨需氧与厌氧配对培养在临床血流感染中的诊断价值。方法采用含树脂需氧瓶和含溶血素厌氧瓶配对培养,统计分析2012年7月至2014年6月送检的11 603份血培养中1 303份阳性菌株的分布和报阳时间。结果 1 303份血培养阳性标本中,厌氧瓶与需氧瓶均生长的有603株,仅需氧瓶生长的483株,仅厌氧瓶生长的217株。双瓶培养阳性率11.23%(1 303/11 603)与仅用单需氧瓶阳性率9.36%(1 086/11 603)或单厌氧瓶培养阳性率7.07%(820/11 603)比较,差异均有统计学意义(P<0.01)。在厌氧瓶中还检出专性厌氧菌10例。双瓶均报阳的603株不同种属分离菌的厌氧瓶报阳时间均值早于需氧瓶。临床常见分离菌属两种培养瓶报阳时间比较具有统计学意义(P<0.05)。结论需氧瓶与厌氧瓶配对培养在增加厌氧菌检出的同时,还能提高血培养的阳性率并缩短检出时长,为临床血流感染诊断和治疗提供依据,可指导临床合理使用抗菌药物。

Objective To evaluate the diagnostic advantages of both aerobic and anaerobic cultures for blood stream infection. Meth- ods We collected 11 603 blood samples for cultures with aerobic bottle containing resin and anaerobic bottle containing hemolysin from July 2012 to June 2014 and analyzed the distribution and alarm time of 1 303 positive strains. Results Of 1 303 positive blood specimens, 603 grew in both bottles, while 483 only in the aerobic bottle and 217 only in the anaerobic bottles. The positive rate of culture with both bottles （11.23%, 1 303/11 603） was significantly higher than that with only aerobic culture （9.36%, 1 086/ 11 603 ） or only anaerobic bottles （7.07%, 820/11 603 ）, in which significant difference was found （P 〈 0.01 ）. In addition, 10 ob- ligate anaerobic bacteria were isolated from anaerobic bottles. The positive alarm time of anaerobic bottles was earlier than that of aero- bic bottle. There was significant difference of the alarm time with the two different bottles for clinical common isolated bacteria （ P 〈 0.05 ）. Conclusion The paired bottles of aerobic and anaerobic culture can not only increase the detectable rate of anaerobic bacteria and the positive rates of blood culture, but also remarkably shorten the detection time, provide the diagnostic basis of bloodstream in- fection and guide the clinical treatment.