全球精选文摘 - 检测血行感染所需血培养次数的评价研究

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检测血行感染所需血培养次数的评价研究

Assessing How Many Blood Cultures Are Needed for Detecting Bloodstream Infections

Nicola FG 2009/5/27 10:49:52

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J Clin Microbiol, 2008,

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Abstract
Background:
The number of blood cultures needed to achieve at least 99% test sensitivity is yet to be determined. An automated detection system was used to detect bloodstream infections (BSIs) in blood samples from adult inpatients. In this study, at least three blood cultures were obtained per patient within 24 hours. Only true infections were considered. The results showed that limiting the number to two blood cultures missed about 10% of the BSIs. The sensitivities for the various microorganisms also varied, with 97% reported for Staphylococcus aureus bacteria and only 85% for Pseudomonas aeruginosa and Candida albicans. How these findings were interpreted, and limitations to the methods used were discussed.

Interpretations:
It was speculated that these findings indicate that detection of low-level bacteremia, using the automated systems, may be enhanced by testing a greater quantity of blood. More cultures may also improve detection in patients who are already taking antibiotics.

Limitations:
Considering only patients who had three samples drawn and cultured, rather than patients who had just two, may have biased the results toward a subpopulation of patients with special clinical situations. If the entire population of patients with suspected BSIs were included, the impact of taking more blood cultures would be more clearly defined. This would identify subpopulations where the added cultures would prove most cost-effective. Another variable not considered was the effect of contamination rates, which increase the laboratory's work load and potentially cause clinical misinterpretation. Some consideration of the requirements of the various microorganisms must also be made. Certain bacteria have strict criteria for growth and others are less picky, occurring in more samples. The protocol used for this study dictated that each blood culture consist of 20-mL samples equally distributed between aerobic and anaerobic medium bottles. The recovery rates of some bacteria are significantly lower in anaerobic media, so the ratio of aerobic to anaerobic media should be increased.

Conclusions:
To determine how many cultures are needed to detect microorganisms in blood with at least 99% accuracy will require further study. These efforts should be prospectively designed to avoid all foreseeable biases.

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疾病资源中心

高血压	慢性阻塞性肺病
脂肪性肝病	糖尿病
卒中	肺癌
冠心病	子宫内膜异位症
结直肠癌	乳腺癌
心力衰竭	心律失常

病例分析 [栏目介绍]

甲状腺功能亢进合并黄疸

王燕燕王曙

上海交通大学附属瑞金医院内分泌科

患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。

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