摘要
目的分析血培养阳性报警时间(TTP)在初步鉴别微生物种类和区分病原菌与污染菌中的价值,为临床早期预警和合理用药提供参考。方法收集2017—2020年内蒙古自治区人民医院所有分离自血流感染(BSI)患者的非重复阳性菌株534株。结合患者临床资料进行综合分析。结果 534株血培养分离菌中,323株(60.5%)TTP≤1 d,454株(85.0%)TTP≤2 d,513株(96.1%)TTP≤3 d。不同微生物TTP中位值不同,从快到慢依次为肠杆菌科(0.57 d)、链球菌属(0.68 d)、非发酵菌属(0.71 d)、肠球菌属(0.72 d)、葡萄球菌属(1.36 d)、酵母菌(1.98 d)、马耳他布鲁杆菌(2.75 d)。肠杆菌科与非发酵菌属和链球菌属比较,TTP差异无统计学意义(P>0.05);与其他细菌比较,差异均有统计学意义(P<0.05)。534株血培养分离菌中检出99株污染菌(18.5%),污染菌1 d内检出率为15.2%,1~2 d检出率为46.5%,2~3 d检出率为26.2%,>3 d检出率为12.1%;TTP≥1 d的可疑污染菌占84.8%。污染菌以凝固酶阴性葡萄球菌(59.6%)和革兰阳性杆菌(9.1%)为主。病原菌与污染菌TTP差异有统计学意义(P<0.05)。结论 BSI患者病原菌种类及其分布复杂,实验室可以根据TTP初步预测菌株类别,区分病原菌和污染菌,指导临床合理用药。
Objective To study the role of time to positive(TTP) of blood culturing in preliminary identification of microbial species and distinguishing between pathogenic bacteria and contaminated bacteria,and to provide a reference for early clinical warning and rational drug use. Methods Totally,534 positive and nonrepetitive isolates from bloodstream infection(BSI) patients in Inner Mongolia Autonomous Region People’s Hospital from 2017 to 2020 were analyzed. A comprehensive analysis was conducted combined with clinical data.Results Among the 534 isolates from blood culturing,323 isolates(60.5%) were determined with TTP≤1 d,454 isolates(85.0%) were determined with TTP≤2 d,and 513 isolates(96.0%) were determined with TTP≤3 d.The median alarm times of positive blood culturing were different,from the fastest to the slowest which were Enterobacteriaceae(0.57 d),Streptococcus(0.68 d),non-fermentative bacterium(0.71 d),Enterococcus(0.72 d),Staphylococcus(1.36 d),yeast(1.98 d) and Brucella melitensis(2.75 d). There was no statistical significance between Enterobacteriaceae TTP and non-fermentative bacterium TTP,Streptococcus TTP(P>0.05),but there was statistical significance between Enterobacteriaceae TTP and Enterococcus,Staphylococcus,yeast and Brucella melitensis(P<0.05). The determination rate of contaminated bacteria in 534 isolates of blood culturing was 18.5%(99 isolates),and the determination rates of contaminated bacteria were 15.2% in 1 d,46.5% in 1-2 d,26.2% in 2-3 d and 12.1% in >3 d. The TTP≥1 d of suspicious contaminated bacteria accounted for 84.8%.Coagulase-negative Staphylococcus(59.6%) and Gram-positive bacilli(9.1%) were the predominant bacteria in contaminated bacteria. The TTP between pathogenic bacteria and contaminated bacteria had statistical significance(P<0.05). Conclusions Pathogenic bacteria and their complex distribution in BSI patients can be preliminarily predicted according to TTP,pathogenic bacteria and contaminated bacteria can be distinguished,and drugs can be used rationally.
作者
赵亚楠
曹啟新
赵建平
ZHAO Yanan;CAO Qixin;ZHAO Jianping(Inner Mongolia Autonomous Region People's Hospital,Huhhot 010010,Inner Mongolia,China)
出处
《检验医学》
CAS
2021年第12期1210-1214,共5页
Laboratory Medicine
基金
内蒙古自治区卫生计生科研计划项目(201702004)。
关键词
血培养
阳性报警时间
病原菌
污染菌
检出率
Blood culturing
Time to positive
Pathogenic bacterium
Contaminated bacterium
Determination rate