血培养布氏杆菌阳性患者的临床诊断及感染特征

Clinical diagnosis and infection characteristics of patients with brucella positive blood bacteria culture

目的探讨血培养布氏杆菌阳性患者的临床诊断及感染特征。方法收集2019年1—12月济宁医学院附属医院送检的13455份临床标本,包括13238份血培养标本和217份骨髓培养标本,使用全自动血培养仪对样本进行检测。需氧瓶阳性报警后观察细菌生长曲线特点,接种于血平板,在35℃、5%CO_(2)培养箱中分离培养,并进行生化鉴定;统计血培养和骨髓培养的阳性报警时间;抽取本组85例疑似布氏杆菌感染患者,了解其临床特征。结果血培养检出马耳他布鲁菌68例,骨髓培养检出16例患者,与85例疑似布氏杆菌感染患者的临床症状相似,均有不规则发热、头痛、乏力以及关节疼痛等,且均具有动物接触史;生长曲线具有相似特点,即生长期较短,生长期对应的纵轴较短,稳定期平缓,符合布氏杆菌的生长特点。1例患者血培养和骨髓培养结果均为阴性,但该患者血培养细菌生长曲线及临床体征都符合布氏杆菌感染,且临床按照布氏杆菌感染治疗方案诊疗成功。在确诊的68例血培养标本中,全自动血培养仪阳性报警平均时间(4.15±0.30)d,16例骨髓培养标本阳性报警平均时间(3.65±0.48)d,骨髓培养较血培养比较阳性报警时间早,阳性率明显高于血培养〔7.37%(16/217)比0.51%(68/13238),P<0.05〕。结论骨髓培养阳性报警时间明显早于血培养,阳性率也明显高于血培养;但鉴于骨髓标本不易采集,不能纳入常规送检,因此采用血培养联合生长曲线特点,有助于快速鉴定布氏杆菌感染,为临床早期诊断布氏杆菌感染抢先治疗提供有力依据,对传染性疾病的遏制有非常重要的价值。

Objective To explore the clinical diagnosis and infection characteristics of patients with brucella positive blood bacteria culture.Methods A total of 13455 clinical samples in the Affiliated Hospital of Jining Medical College from January to December 2019 were collected,including 13238 blood culture samples and 217 bone marrow culture samples.The samples were tested with automatic blood culture instrument.After the positive alarm of the aerobic flask,the characteristics of the bacterial growth curve were observed,and then the bacteria were inoculated on the blood plate.The isolation,culture and biochemical identification were conducted in 35℃,5%CO_(2) incubator.The positive alarm time of blood culture and bone marrow culture was counted.The 85 patients with suspected brucella infection were selected to understand the clinical characteristics.Results The clinical symptoms of 68 patients with brucella maltaetica detected in blood culture and 16 patients with bone marrow culture were similar to those of 85 patients with suspected brucella infection,including irregular fever,headache,fatigue and joint pain,with animal contact history.At the same time,it had the same characteristic growth curve,the growth period was short,the vertical axis corresponding to the growth period was short,and the stable period was gentle,which conformed to the characteristics of the growth curve of brucella.One patient's blood culture and bone marrow culture results were negative,but the growth curve of blood culture bacteria and clinical signs were consistent with those of patients with brucella infection.The clinical treatment was successful according to the brucellosis protocol.The average positive alarm time of automatic blood culture instrument was(4.15±0.30)days in 68 confirmed blood culture patients,and the average time of bone marrow culture was(3.65±0.48)days in 16 patients.The positive alarm time of bone marrow culture was earlier than that of blood culture,and the positive rate was higher than that of blood culture[7.37%(16/217)vs.0.51%(68/13238),P<0.05].Conclusions The positive alarm time of bone marrow culture was earlier than that of blood culture,and the positive rate was also significantly higher than that of blood culture.However,in view of the fact that bone marrow samples are not easy to collect and cannot be included in the routine submission for examination,the use of blood culture combined with growth curve characteristics is conducive to rapid estimation of brucella infection,which provides a strong help for early clinical diagnosis of brucella infection and preemptive treatment,and is of great value for the containment of infectious diseases.