BACKGROUND A reliable test is essential for diagnosing Helicobacter pylori(H.pylori)infection,and crucial for managing H.pylori-related diseases.Serving as an excellent method for detecting H.pylori infection,histolog...BACKGROUND A reliable test is essential for diagnosing Helicobacter pylori(H.pylori)infection,and crucial for managing H.pylori-related diseases.Serving as an excellent method for detecting H.pylori infection,histologic examination is a test that clinicians heavily rely on,especially when complemented with immunohistochemistry(IHC).Additionally,other diagnostic tests for H.pylori,such as the rapid urease test(CLO test)and stool antigen test(SA),are also highly sensitive and specific.Typically,the results of histology and other tests align with each other.However,on rare occasions,discrepancy between histopathology and other H.pylori diagnostic tests occurs.AIM To investigate the discordance between histology and other H.pylori tests,the underlying causes,and the impact on clinical management.METHODS Pathology reports of gastric biopsies were retrieved spanning August 2013 and July 2018.Reports were included in the study only if there were other H.pylori tests within seven days of the biopsy.These additional tests include CLO test,SA,and H.pylori culture.Concordance between histopathology and other tests was determined based on the consistency of results.In instances where histology results were negative while other tests were positive,the slides were retrieved for re-assessment,and the clinical chart was reviewed.RESULTS Of 1396 pathology reports were identified,each accompanied by one additional H.pylori test.The concordance rates in detecting H.pylori infection between biopsy and other tests did not exhibit significant differences based on the number of biopsy fragments.117 discrepant cases were identified.Only 20 cases(9 with CLO test and 11 with SA)had negative biopsy but positive results in other tests.Four cases initially stained with Warthin-Starry turned out to be positive for H.pylori with subsequent IHC staining.Among the remaining 16 true discrepant cases,10 patients were on proton pump inhibitors before the biopsy and/or other tests.Most patients underwent treatment,except for two who were untreated,and two patients who were lost to follow-up.CONCLUSION There are rare discrepant cases with negative biopsy but positive in SA or CLO test.Various factors may contribute to this inconsistency.Most patients in such cases had undergone treatment.展开更多
目的:评估欧洲抗菌药物敏感性试验委员会(EUCAST)血培养阳性瓶快速药敏试验(RAST)在临床上的适用性。方法:对2022年我院血培养阳性样本进行收集,按照2022年EUCAST发布的RAST version 5.1指南,对大肠埃希菌、肺炎克雷伯菌及金黄色葡萄球...目的:评估欧洲抗菌药物敏感性试验委员会(EUCAST)血培养阳性瓶快速药敏试验(RAST)在临床上的适用性。方法:对2022年我院血培养阳性样本进行收集,按照2022年EUCAST发布的RAST version 5.1指南,对大肠埃希菌、肺炎克雷伯菌及金黄色葡萄球菌共115株进行快速药敏试验。在4h、6h、8h及16~20h时刻分别读取药敏结果,并与Vitek 2 Compact全自动微生物鉴定及药敏系统的结果进行对比。结果:RAST在不同时间点(4h、6h、8h及16~20h)的抑菌圈量取比例分别为91.3%、99.1%、100.0%以及100.0%。金黄色葡萄球菌在4h读取能力差。判读细菌药敏结果可得,所有抗菌药物在4h、6h、8h、16~20h时的RAST结果平均CA比例上升,ATU下降。其中16~20h细菌药敏结果的符合率最优,4h最差,6h和8h较为接近。4h、6h、8h、16~20h判读CA比例最高的药物分别为NOR、MEM和NOR、MEM和NOR、MEM和NOR,CA最低的为DA、DA、LEV、DA。4h、6h、8h大肠埃希菌CA比例上升,ATU比例下降;4h、6h、8h、16~20h肺炎克雷伯菌CA比例和ATU比例下降;4h、6h、8h、16~20h金黄色葡萄球菌ATU比例均上升,CA比例在6h最低;组间比较基本无统计学差异(P>0.05)。大肠埃希菌、肺炎克雷伯菌4h、6h、8h、16~20h的VME、ME、mE的误差率均分别符合≤1.5%、≤3.0%、<10%的要求;而金黄色葡萄球菌各时间段VME、ME均不符合要求,mE均符合要求。CTX在4h、6h、8h筛查ESBL阳性大肠埃希菌的符合率均为100.0%,而CAZ符合率分别为75.0%、76.9%、74.1%;CTX在4h、6h、8h筛查ESBL阳性肺炎克雷伯菌符合率均为75.0%,而CAZ符合率分别为50.0%、25.0%、25.0%。结论:EUCAST血培养阳性瓶RAST具有较高的临床准确性,能为临床医生提供快速而准确的治疗建议,对于改进感染病例的临床管理具有潜在价值。EUCAST血培养RAST方法,大肠埃希菌、肺炎克雷伯菌血培养标本快速药敏结果与常规结果一致性好,4h可作为RAST药敏判读的时间点。金黄色葡萄球菌生长速度较肠杆菌目慢,收集例数较少,导致VME、ME比例偏高,4h的可量取比例较低,建议在6h进行判读。展开更多
Introduction: H. pylori is a primary pathogen isolated by Warren and Marshall in 1983. They called it as Campylobacter Pylori and in 1989 Goodwin et al. renamed it as Helicobacter pylori. Helicobacter pylorus is one o...Introduction: H. pylori is a primary pathogen isolated by Warren and Marshall in 1983. They called it as Campylobacter Pylori and in 1989 Goodwin et al. renamed it as Helicobacter pylori. Helicobacter pylorus is one of the responsible factors for causing gastritis, Peptic ulcer disease and is strongly associated with gastric carcinoma and gastric Malt lymphoma. Materials and Methods: In this study 300 biopsies were collected at Deccan College of Medical Sciences and Allied Hospitals, Hyderabad, India. Of these, 101 patients had peptic ulcer, 95 patients had gastritis and 4 had gastric carcinoma. A total of four gastric biopsy specimens were collected. One was used for culturing H. pylori, one for histological lesions and the remaining two one each from the antrum & corpus was collected in phosphate buffered saline for the DNA analysis. Results: Helicobacter pylori were isolated from many of the biopsies and the identification of Helicobacter pylori was confirmed in 200 biopsies with colony characteristics, Biochemical tests, and 16S rRNA amplification. The presence of VacA marker was detected by using appropriate primers. From the data obtained in our study, in a total of 169/200 isolates s1 region was found in 84.1% and s2 was found in 36/200 i.e. 18% of the isolates. In the middle region, m1awas found in 60/200 which was 30%, m1b was found in 60/200 i.e. 60% and m2 was found in 114/200 i.e. 57.1% of the isolates. Conclusion: Thus, VacA detection might be helpful for determination of which patients are at highest risk for severe clinical outcomes such as duodenal ulcer, gastric ulcer or gastric carcinoma and eventually, to define strategies for the treatment or prevention of H. pylori infection.展开更多
目的研究微生物快速培养检测在小儿肺炎支原体感染中的诊断价值。方法878例疑似肺炎支原体感染患儿,均进行快速血清学检验、微生物快速培养检测。以支原体培养结果作为金标准,比较不同检验方法的诊断效能;比较不同年龄、症状持续时间确...目的研究微生物快速培养检测在小儿肺炎支原体感染中的诊断价值。方法878例疑似肺炎支原体感染患儿,均进行快速血清学检验、微生物快速培养检测。以支原体培养结果作为金标准,比较不同检验方法的诊断效能;比较不同年龄、症状持续时间确诊患儿不同检验方法的阳性符合率。结果878例疑似患儿中共确诊768例(87.47%),快速血清学检验的阳性检出率为83.49%(733/878),与微生物快速培养检测的86.67%(761/878)比较差异无统计学意义(χ^(2)=3.517,P=0.061>0.05)。微生物快速培养检测的诊断敏感度、特异度、准确度、阳性预测值、阴性预测值分别为98.44%、95.45%、98.06%、99.34%、89.74%,均高于快速血清学检验的93.23%、84.55%、92.14%、97.68%、64.14%,差异具有统计学意义(P<0.05)。768例确诊患儿中,0~3岁300例,4~7岁162例,8~12岁188例,>12岁118例。0~3岁、4~7岁、8~12岁患儿微生物快速培养检测的阳性符合率分别为98.33%、97.53%、98.40%,均高于快速血清学检验的94.67%、87.65%、92.55%,差异具有统计学意义(P<0.05);年龄>12岁患儿不同检验方法的阳性符合率比较差异无统计学意义(P>0.05)。768例确诊患儿中,症状持续时间<7 d 410例,症状持续时间≥7 d 358例。症状持续时间<7 d、≥7 d患儿微生物快速培养检测的阳性符合率分别为98.05%、98.88%,均高于快速血清学检验的90.49%、96.37%,差异具有统计学意义(P<0.05)。结论微生物快速培养检测应用于小儿肺炎支原体感染的诊断中具有较高的准确性,能够为临床诊疗提供更可靠的参考依据。展开更多
文摘BACKGROUND A reliable test is essential for diagnosing Helicobacter pylori(H.pylori)infection,and crucial for managing H.pylori-related diseases.Serving as an excellent method for detecting H.pylori infection,histologic examination is a test that clinicians heavily rely on,especially when complemented with immunohistochemistry(IHC).Additionally,other diagnostic tests for H.pylori,such as the rapid urease test(CLO test)and stool antigen test(SA),are also highly sensitive and specific.Typically,the results of histology and other tests align with each other.However,on rare occasions,discrepancy between histopathology and other H.pylori diagnostic tests occurs.AIM To investigate the discordance between histology and other H.pylori tests,the underlying causes,and the impact on clinical management.METHODS Pathology reports of gastric biopsies were retrieved spanning August 2013 and July 2018.Reports were included in the study only if there were other H.pylori tests within seven days of the biopsy.These additional tests include CLO test,SA,and H.pylori culture.Concordance between histopathology and other tests was determined based on the consistency of results.In instances where histology results were negative while other tests were positive,the slides were retrieved for re-assessment,and the clinical chart was reviewed.RESULTS Of 1396 pathology reports were identified,each accompanied by one additional H.pylori test.The concordance rates in detecting H.pylori infection between biopsy and other tests did not exhibit significant differences based on the number of biopsy fragments.117 discrepant cases were identified.Only 20 cases(9 with CLO test and 11 with SA)had negative biopsy but positive results in other tests.Four cases initially stained with Warthin-Starry turned out to be positive for H.pylori with subsequent IHC staining.Among the remaining 16 true discrepant cases,10 patients were on proton pump inhibitors before the biopsy and/or other tests.Most patients underwent treatment,except for two who were untreated,and two patients who were lost to follow-up.CONCLUSION There are rare discrepant cases with negative biopsy but positive in SA or CLO test.Various factors may contribute to this inconsistency.Most patients in such cases had undergone treatment.
文摘目的:评估欧洲抗菌药物敏感性试验委员会(EUCAST)血培养阳性瓶快速药敏试验(RAST)在临床上的适用性。方法:对2022年我院血培养阳性样本进行收集,按照2022年EUCAST发布的RAST version 5.1指南,对大肠埃希菌、肺炎克雷伯菌及金黄色葡萄球菌共115株进行快速药敏试验。在4h、6h、8h及16~20h时刻分别读取药敏结果,并与Vitek 2 Compact全自动微生物鉴定及药敏系统的结果进行对比。结果:RAST在不同时间点(4h、6h、8h及16~20h)的抑菌圈量取比例分别为91.3%、99.1%、100.0%以及100.0%。金黄色葡萄球菌在4h读取能力差。判读细菌药敏结果可得,所有抗菌药物在4h、6h、8h、16~20h时的RAST结果平均CA比例上升,ATU下降。其中16~20h细菌药敏结果的符合率最优,4h最差,6h和8h较为接近。4h、6h、8h、16~20h判读CA比例最高的药物分别为NOR、MEM和NOR、MEM和NOR、MEM和NOR,CA最低的为DA、DA、LEV、DA。4h、6h、8h大肠埃希菌CA比例上升,ATU比例下降;4h、6h、8h、16~20h肺炎克雷伯菌CA比例和ATU比例下降;4h、6h、8h、16~20h金黄色葡萄球菌ATU比例均上升,CA比例在6h最低;组间比较基本无统计学差异(P>0.05)。大肠埃希菌、肺炎克雷伯菌4h、6h、8h、16~20h的VME、ME、mE的误差率均分别符合≤1.5%、≤3.0%、<10%的要求;而金黄色葡萄球菌各时间段VME、ME均不符合要求,mE均符合要求。CTX在4h、6h、8h筛查ESBL阳性大肠埃希菌的符合率均为100.0%,而CAZ符合率分别为75.0%、76.9%、74.1%;CTX在4h、6h、8h筛查ESBL阳性肺炎克雷伯菌符合率均为75.0%,而CAZ符合率分别为50.0%、25.0%、25.0%。结论:EUCAST血培养阳性瓶RAST具有较高的临床准确性,能为临床医生提供快速而准确的治疗建议,对于改进感染病例的临床管理具有潜在价值。EUCAST血培养RAST方法,大肠埃希菌、肺炎克雷伯菌血培养标本快速药敏结果与常规结果一致性好,4h可作为RAST药敏判读的时间点。金黄色葡萄球菌生长速度较肠杆菌目慢,收集例数较少,导致VME、ME比例偏高,4h的可量取比例较低,建议在6h进行判读。
文摘Introduction: H. pylori is a primary pathogen isolated by Warren and Marshall in 1983. They called it as Campylobacter Pylori and in 1989 Goodwin et al. renamed it as Helicobacter pylori. Helicobacter pylorus is one of the responsible factors for causing gastritis, Peptic ulcer disease and is strongly associated with gastric carcinoma and gastric Malt lymphoma. Materials and Methods: In this study 300 biopsies were collected at Deccan College of Medical Sciences and Allied Hospitals, Hyderabad, India. Of these, 101 patients had peptic ulcer, 95 patients had gastritis and 4 had gastric carcinoma. A total of four gastric biopsy specimens were collected. One was used for culturing H. pylori, one for histological lesions and the remaining two one each from the antrum & corpus was collected in phosphate buffered saline for the DNA analysis. Results: Helicobacter pylori were isolated from many of the biopsies and the identification of Helicobacter pylori was confirmed in 200 biopsies with colony characteristics, Biochemical tests, and 16S rRNA amplification. The presence of VacA marker was detected by using appropriate primers. From the data obtained in our study, in a total of 169/200 isolates s1 region was found in 84.1% and s2 was found in 36/200 i.e. 18% of the isolates. In the middle region, m1awas found in 60/200 which was 30%, m1b was found in 60/200 i.e. 60% and m2 was found in 114/200 i.e. 57.1% of the isolates. Conclusion: Thus, VacA detection might be helpful for determination of which patients are at highest risk for severe clinical outcomes such as duodenal ulcer, gastric ulcer or gastric carcinoma and eventually, to define strategies for the treatment or prevention of H. pylori infection.
文摘目的研究微生物快速培养检测在小儿肺炎支原体感染中的诊断价值。方法878例疑似肺炎支原体感染患儿,均进行快速血清学检验、微生物快速培养检测。以支原体培养结果作为金标准,比较不同检验方法的诊断效能;比较不同年龄、症状持续时间确诊患儿不同检验方法的阳性符合率。结果878例疑似患儿中共确诊768例(87.47%),快速血清学检验的阳性检出率为83.49%(733/878),与微生物快速培养检测的86.67%(761/878)比较差异无统计学意义(χ^(2)=3.517,P=0.061>0.05)。微生物快速培养检测的诊断敏感度、特异度、准确度、阳性预测值、阴性预测值分别为98.44%、95.45%、98.06%、99.34%、89.74%,均高于快速血清学检验的93.23%、84.55%、92.14%、97.68%、64.14%,差异具有统计学意义(P<0.05)。768例确诊患儿中,0~3岁300例,4~7岁162例,8~12岁188例,>12岁118例。0~3岁、4~7岁、8~12岁患儿微生物快速培养检测的阳性符合率分别为98.33%、97.53%、98.40%,均高于快速血清学检验的94.67%、87.65%、92.55%,差异具有统计学意义(P<0.05);年龄>12岁患儿不同检验方法的阳性符合率比较差异无统计学意义(P>0.05)。768例确诊患儿中,症状持续时间<7 d 410例,症状持续时间≥7 d 358例。症状持续时间<7 d、≥7 d患儿微生物快速培养检测的阳性符合率分别为98.05%、98.88%,均高于快速血清学检验的90.49%、96.37%,差异具有统计学意义(P<0.05)。结论微生物快速培养检测应用于小儿肺炎支原体感染的诊断中具有较高的准确性,能够为临床诊疗提供更可靠的参考依据。
