4313份血样细菌培养结果分析

发布时间：2018-11-08 10:39

【摘要】：目的收集血培养阳性标本的实验室参数和临床参数,结合临床随访和抗感染治疗转归,分析真正致病菌的构成和实验室特征。方法前瞻性研究2013年3月到2015年3月我院4 313份临床送检血培养标本中分离出的483株病原菌,对每份阳性培养结果进行实验室及临床感染参数的收集,并跟踪进行临床随访,了解临床责任医生的经验判断及针对性抗生素治疗的临床转归。综合分析后确定真正的致病菌与污染菌。结果 483株阳性分离菌中,最终判定为致病菌的331株(68.5%),污染菌97株(20.1%),不确定致病与否的55株(11.4%),其中,致病菌中大肠埃希菌所占比例最高,为41.2%,污染菌中凝固酶阴性葡萄球菌比例最高,为75.3%;仅从需氧瓶或厌氧瓶中检出的病原菌为253株(占52.4%),其中大肠埃希菌在厌氧瓶中检出率(23.9%)高于需氧瓶(13.8%)(P0.05);判定为污染的97株阳性分离菌中,仅从1瓶中分离的90株(92.8%),两瓶以上分离的7株(7.2%)(χ2=142,P0.05),24h内报阳的34株(35.1%),48h内报阳的77株(79.4%),48h内报阳污染菌的比例高于24h(χ2=38.935,P=0.000),差异有统计学意义。结论血培养中污染菌的确立不能简单依靠实验室或临床参数,要同时结合临床医生经验及临床治疗反应综合判断;对于实验室判断污染与否的指标,报阳瓶数和报阳时间依然是2个具有重要价值的因素;重视厌氧瓶的送检更有利于大肠埃希菌的检出。
[Abstract]:Objective to collect the laboratory and clinical parameters of positive blood culture specimens, and analyze the composition and laboratory characteristics of real pathogenic bacteria by clinical follow-up and antiinfective therapy. Methods from March 2013 to March 2015, 483 strains of pathogenic bacteria were isolated from 4 313 blood samples from our hospital. The laboratory and clinical infection parameters of each positive culture result were collected and followed up. To understand the experience and judgment of clinical responsible doctors and the clinical outcome of targeted antibiotic therapy. After comprehensive analysis, the real pathogenic bacteria and contaminated bacteria were identified. Results among 483 positive isolates, 331 strains (68.5%) were identified as pathogenic bacteria, 97 strains (20.1%) were contaminated bacteria, 55 strains (11.4%) were uncertain whether they were pathogenic or not. Among them, Escherichia coli accounted for the highest proportion of pathogenic bacteria. The proportion of coagulase-negative staphylococcus in contaminated bacteria was the highest, 75.3; 253 strains (52.4%) were isolated from aerobic or anaerobic flasks. The positive rate of Escherichia coli in anaerobic flasks (23.9%) was higher than that in aerobic flasks (13.8%) (P0.05). Of 97 positive strains identified as contaminated, only 90 strains (92.8%) were isolated from 1 bottle, 7 strains (7.2%) were isolated from more than two bottles (蠂 2 142P 0.05), 34 strains (35.1%) were positive within 24 hours. 77 strains (79.4%) reported positive within 48 h, and the proportion of positive bacteria reported in 48 h was higher than that in 24 h (蠂 2, 38.935, P < 0. 000), the difference was statistically significant. Conclusion the establishment of contaminated bacteria in blood culture should not simply depend on laboratory or clinical parameters, but should be combined with the experience of clinicians and the comprehensive judgment of clinical treatment reaction. The number of positive bottles and the time of positive detection are still two important factors for the laboratory to judge the pollution or not, and it is more beneficial to detect Escherichia coli by paying attention to the anaerobic bottles.
【作者单位】：西安交通大学医学院附属三二0一医院微生物免疫科;西安交通大学医学部医学免疫学与病原生物学系;
【分类号】：R446.5

【相似文献】