采用多指标评价血培养污染率的临床应用

Clinical application of multiple indexes in evaluating blood culture contamination rate

目的 回顾性分析血培养阳性结果，结合临床资料了解血培养污染情况。 方法 采用回顾性研究方法，对大连医科大学附属一院2016年7月至2017年7月血培养结果进行分析。结合患者的临床资料，探讨血培养中检出凝固酶阴性葡萄球菌（CNS）的临床意义。 结果 从临床送检双套及多套血培养瓶共分离到菌株501株。其中阴性杆菌285株，占56.9%；阳性球菌182株，占36.3%；真菌13株，占2.6%；微球菌等污染菌21株，占4.2%。119株CNS中引起血流感染的有24例，占20.2%。1瓶阳性判断为血流感染的为8例，占 33.4% ，阳性预测值为14.8%；2瓶6例占25.0%，阳性预测值为14.8%；3瓶5例占20.8%，阳性预测值为 55.6% ；4瓶5例占20.8%，阳性预测值为71.4%。 结论 血培养阳性结果评价很重要，需要结合实验室数据及临床资料综合分析才能治疗感染而不是治疗污染。

Objective ： To analysis of blood culture positive results by retrospectively analyzing,combined with clinical data to understand the situation of blood culture contamination. Methods ： To analyze the results of blood culture in the First Affiliated Hospital of Dalian Medical University from July 2016 to July 2017by retrospectively analyzing.To discuss the clinical significance of coagulase negative Staphylococcus（CNS）from blood culture combined with clinical data. Results： There were 501 strains isolated from clinical samples of two sets and multiple sets of blood culture bottles.There were 285（56.9%） Gram-negative bacteria,182（36.3%） Gram-positive bacteria,13（2.6%） fungi and 21（4.2%） Microsphere bacteria and other contaminated bacteria.Of the 119 patients with the blood cultured positive for CNS,there were 24（20.2%）cases of bacteremia caused by the CNS.there were 8（33.4%） cases of bloodstream infections with one bottle cultured positive,the positive predictive value was 14.8%.6（25.0%） cases with two bottles cultured positive,the positive predictive value was 14.8%.5（20.8%） cases with three bottles cultured positive,the positive predictive value was 55.6%.5（20.8%） cases with four bottles cultured positive,the positive predictive value was 71.4%. Conclusion ： It is important to evaluate the positive result of blood culture,and it is needed to combine the laboratory data and the clinical data to treat the infection rather than the treatment of pollution.