血培养报阳时间对临床病原菌的预测价值及临床意义

Predictive value and clinical significance of time to positivity in blood culture for clinical pathogens

①目的探讨不同种类病原菌血培养阳性报警时间特点,为临床血流感染早期诊断和治疗提供依据。②方法收集华北理工大学附属医院2015年7月1日~2018年6月30日门诊及住院患者血培养阳性标本2094份,分析不同病原菌阳性报警时间的特点。③结果①2094份血培养阳性标本包括革兰阴性杆菌1318株(62.94%),革兰阳性球菌578株(27.6%),棒状杆菌属82株(3.92%),念珠菌56株(2.67%),厌氧菌30株(1.43%),布鲁氏菌属20株(0.96%),单核细胞增生性李斯特菌10株(0.48%)。②从不同种类病原菌平均报阳时间来看,革兰阴性杆菌平均报阳时间为(19.59±17.18)小时,其余菌种分别为革兰阳性球菌(23.69±14.55)小时、念珠菌(36.03±20.27)小时、厌氧菌(50.40±29.40)小时、棒状杆菌属(56.93±25.59)小时、布鲁氏菌属(72.08±14.79)小时,差异有统计学意义(P<0.05)。③革兰阳性球菌中,金黄色葡萄球菌平均报阳时间(19.98±12.02)小时,凝固酶阴性葡萄球菌(29.19±16.19)小时,差异有统计学意义(P<0.05);革兰阴性杆菌中肠杆菌科细菌平均报阳时间(16.86±13.35)小时,非发酵菌(29.13±23.34)小时,差异有统计学意义(P<0.05)。④按不同培养环境来看,链球菌属厌氧瓶平均报阳时间(15.06±5.39)小时,需氧瓶(18.65±11.15)小时,差异有统计学意义(P<0.05);肠杆菌科细菌厌氧瓶平均报阳时间(15.51±9.57)小时,需氧瓶(17.89±15.55)小时,差异有统计学意义(P<0.05)。④结论血培养阳性瓶报阳时间结合报阳曲线和显微镜下涂片形态特点,可以初步判断致病菌种类,为临床血流感染的早期诊断和治疗提供依据。

Objective To explore the characteristics of positive alarm time of different kinds of pathogenic bacteria blood culture,and to provide the basis for the early diagnosis and treatment of clinical blood stream infection.Methods The positive blood culture specimens were collected from outpatients and inpatients in our hospital from July 1,2015 to June 30,2018,and the characteristics of positive alarm time of different pathogens bacteria were analyzed.Results①A total of 2094 positive blood culture specimens were collected,including gram negative bacilli(1318,62.94%),gram positive cocci(578,27.6%),corynebacterium(82,3.92%),candida(56,2.67%),anaerobic bacteria(30,1.43%),brucella(20,0.96%)and listeria monocytogenes(10,0.48%).②The average positive time of gram negative bacilli was(19.59±17.18)h,which was shorter than that of gram positive cocci(23.69±14.55)h,candida(36.03±20.27)h,anaerobic bacteria(50.40±29.40)h,corynebacterium(56.93±25.59)h and brucella(72.08±14.79)h respectively,and the difference was statistically significant(P<0.05).③Among gram positive cocci,the mean positive time of staphylococcus aureus(19.98±12.02)h was significantly shorter than that of coagulase-negative staphylococcus(29.19±16.19)h,and the difference was statistically significant(P<0.05).Among gram negative bacilli,the mean positive time of enterobacteriaceae bacteria(16.86±13.35)h was significantly shorter than that of nonfermentative bacteria(29.13±23.34)h,and the difference was statistically significant(P<0.05).④According to different culture environment,the average positive time of streptococcus in anaerobicbottles(15.06±5.39)h was shorter than that in aerobic bottles(18.65±11.15)h,and the difference was statistically significant(P<0.05).The average positive time of enterobacteriaceae bacterial in anaerobic bottles(15.51±9.57)h was shorter than that in aerobic bottles(17.89±15.55)h,and the difference was statistically significant(P<0.05).Conclusion By analyzing the positive time of blood culture positive bottle,combining with the positive curve and microscopic smear morphological characteristics,we can preliminarily determine the pathogenic bacteria species,and provide the basis for early diagnosis and treatment of clinical blood stream infection.