血培养阳性标本处理流程再造的初步探索

发布时间：2018-02-26 06:33

  本文关键词： 血流感染 血培养阳性标本处理流程 基质辅助激光解析电离飞行时间质谱 直接药敏试验　出处：《上海交通大学学报(医学版)》2017年07期 　论文类型：期刊论文

【摘要】：目的·以分离胶促凝管联合Microflex?基质辅助激光解析电离飞行时间质谱直接检测血培养阳性标本中细菌,并依据质谱鉴定结果进行直接药敏试验,对传统血培养阳性标本处理流程再造进行初步探索。方法·收集2015年9月1日至2016年8月31日上海交通大学医学院附属新华医院临床微生物实验室血培养报阳单菌株感染标本449份,按照新的血培养阳性标本处理流程进行操作。改造后的新处理流程主要包括:涂片染色镜检、分离胶/质谱直接鉴定、菌膜/质谱鉴定、纯菌落/质谱鉴定、直接药敏试验和常规药敏试验等。依据镜检、鉴定与药敏试验结果依次发出:Ⅰ级直接镜检报告、阳性血培养Ⅱ级(直接鉴定/菌膜鉴定或直接药敏)报告和Ⅲ级最终报告。结果·改造后的新处理流程在工作当日10:00、17:00和次日10:00可分别获得82.2%、95.8%和100%阳性血标本中细菌"种"水平鉴定结果并报告至临床;对于经初步评估有临床意义的病原菌在血培养阳性报警次日就能发出初步药敏结果报告,且与常规药敏结果有较高的符合率。结论·与传统处理流程相比,改造后的处理流程使得血培养瓶阳性报警至发送初步鉴定和药敏结果所需时间缩短1~2 d,为临床医师提供快速准确的血流感染病原学诊断依据,对提高临床血流感染的早期诊断和治疗能力具有重要意义。
[Abstract]:Objective: to combine microflexx? Matrix assisted laser desorption ionization time of flight mass spectrometry was used to detect bacteria in blood culture positive samples, and direct drug sensitivity test was carried out based on the results of mass spectrometry. Methods: from September 1st 2015 to August 31st 2016, the clinical microbiology laboratory of Xinhua Hospital of Shanghai Jiaotong University was collected. 449 strains were infected, According to the new blood culture positive sample processing procedure, the modified new treatment procedure mainly includes: smear staining microscopy, isolation / mass spectrometry direct identification, bacteria membrane / mass spectrometry identification, pure colony / mass spectrometry identification, the new treatment process mainly include: smear staining microscopy, isolation / mass spectrometry identification, bacterial membrane / mass spectrometry identification, pure colony / mass spectrometry identification, Direct drug sensitivity test and routine drug sensitivity test, etc. According to the results of microscopic examination, the results of identification and drug sensitivity test were issued successively: grade I direct microscopic examination report, The positive blood culture grade 鈪，

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