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1.
目的:了解不同送检模式的血培养阳性率与病原菌的分布状况。方法:采用BD FX400全自动血培养仪对2013年全年送检的血液标本进行培养,阳性标本做病原菌鉴定,对不同送检模式血培养阳性率与病原菌进行分析。结果:5565份血培养标本,培养出687株病原菌,阳性率为12.3%(687/5565);其中双侧双瓶血培养送检率为87.6%(4875/5565),阳性率为12.8%(624/4875),明显高于单侧单瓶的阳性率9.0%(30/335)(χ2=0.0025,P<0.005)及双侧单瓶的阳性率9.3%(33/355),但与后者比较无统计学意义。双侧双瓶和双侧单瓶血培养病原菌检出率最高的均为大肠埃希菌,分别为27.6%(172/624)和30.3%(10/33);而单侧单瓶血培养病原菌检出率最高的则为凝固酶阴性的葡萄球菌,占40%(12/30),此菌在双侧双瓶和双侧单瓶病原菌中各占12.8%(80/624)和18.2%(6/33)。在双侧双瓶标本分离的624株病原菌中,有77株仅在厌氧瓶中生长,占血培养总菌株11.2%(77/687)。结论:双侧双瓶血培养送检模式提高了血培养阳性率,降低了漏检率,有利于提高血培养检验质量。  相似文献   

2.
ICU是重症医学科的临床基地,是医院集监护和救治重症患者的专业科室,应用先进的诊断、监护和治疗设备与技术,对病情进行连续、动态的定性和定量观察,并通过有效的干预措施为重症患者提供规范高质量的生命支持,改善生存质量.危重患者的生命支持水平和护理质量,直接反映医院的综合救治能力.我国的ICU经过近三十年的发展,已具有一定规模,被大人民群众所接受.目前具备条件的二级以上综合医院均设有重症医学科,但基层医院ICU护理现状不尽人意,尚待解决.  相似文献   

3.
目的:了解南充市某医院冷沉淀的临床使用情况,进而加强冷沉淀的输注管理。方法收集南充市某医院2012年1月1日~2013年12月30日2年的冷沉淀的数据,根据临床各科室的使用情况,统计各科室的用量,对2012年~2013年2年的冷沉淀用量统计分析。结果2012年~2013年2年本院共输注879.0U,其中A型287.0U(33%),B型190.0U(22%),O型342.0U(38%),AB型60.0U(7%),应用科室主要分布在重症医学科(ICU)、心胸外科、普外科等。结论随着医学的发展,冷沉淀的临床应用数量逐年增加,冷沉淀的临床使用范围逐渐变广。  相似文献   

4.
目的探讨重症医学科新护士专科护理培训模式和考核体系。方法 2014—2018年,针对在北京协和医院重症医学科的新护士,实施4个阶段的培训,前3个阶段培训后分别有考核的培训体系。结果科室21名新护士入科室之后参加规范化培训,刚入科的考试通过率为28%。2周后,第一阶段考核通过率为95.2%,得到显著提高(P0.05)。6周后,第二阶段考核合格率为72.0%(P0.05)。第24周后考核合格率为96.2%(P0.05)。结论重症医学科新护士的基础理论知识、专业技能和重症思维相对薄弱,经过系统化培训后均可得到提高。"理论考核+操作考核+临床思维考核"模式有助于评价和提高新护士的护理能力。  相似文献   

5.
目的:了解徐医附院2013—2015年临床分离鲍曼不动杆菌的临床分布特征及对抗菌药物的耐药性变迁,为临床合理使用抗菌药物提供依据。方法:对2013—2015年徐医大附院收集的所有鲍曼不动杆菌临床数据进行分析。结果:2013—2015年共收集鲍曼不动杆菌1664株,其中在临床ICU科室检出率最高,占58.2%。临床分离的鲍曼不动杆菌耐药严重,其中对碳青霉烯类抗菌药物的耐药率已高达73.0%以上。对其他β内酰胺类、头孢菌素类等抗菌药物的耐药率总体维持在70.0%~80.0%之间。结论:鲍曼不动杆菌感染在ICU最为严重,且对常规抗生素耐药率普遍较高。应加强鲍曼不动杆菌耐药监测,以提高临床对感染性疾病的诊治疗效。  相似文献   

6.
目的重症医学在基层医院的实施仍存在不规范的现象。本文主要探讨和总结基层医院的重症临床诊治思路的教学模式。方法由重症基层协作组针对基层医院,撰写7个重症临床诊治思路规范流程,并于2017年在全国基层医院范围内应用,从"理论讲解-案例分析-模拟实战"的教学模式开展教学培训,于培训前后,通过考试评价培训效果。结果总共有15个省共573名重症医学科的临床医生参加培训,培训前考试答题正确率49%,培训后考试答题正确率61%。结论基层医院的重症医生重症诊疗思路能力薄弱,相关教育培训需要继续加强。以"理论讲解-案例分析-模拟实战"的培训模式有助于提高ICU医生重症临床诊疗思路的能力。  相似文献   

7.
目的 总结重症医学科(ICU)重症患者急性胃肠功能障碍的发生及其预后。方法 选取2008年1月—2012年12月收住蚌埠医学院第一附属医院重症医学科的重症患者3 321例为研究对象,观察其急性胃肠损伤(AGI)的发生率;根据AGI严重程度分为AGI Ⅰ~Ⅳ组,观察比较4组重症患者的年龄、性别、急性生理学与慢性健康评估(APACHE)Ⅱ评分等一般指标,以及ICU留治时间和病死率。结果 本组3 321例中,并发AGI者2 261例,发病率68.08%,其中AGI Ⅰ级~Ⅳ级例数依次为1 123例(33.81%)、586例(17.65%)、367例(11.05%)、185例(5.57%)。男/女比例、年龄在AGI Ⅰ~Ⅳ级4组患者间比较,差异无统计学意义(P值均〉0.05);而APACHEⅡ评分、ICU留治时间在4组间比较,差异有统计学意义(P值均〈0.01)。在纳入研究3 321例重症患者中,病死率为4.73%(157/3 321);其中AGI Ⅰ~Ⅳ级病死率依次为2.76%(31/1 123)、6.31%(37/586)、9.81%(36/367)、28.65%(53/185),4组间比较,差异有统计学意义(χ2=170.316,P=0.000)。结论 重症患者的急性胃肠功能障碍发生率高,严重影响患者预后。  相似文献   

8.
目的 分析血培养病原菌阳性标本的病原菌分布特征及药物敏感性,为临床合理用药提供依据.方法 回顾性分析广州医科大学附属顺德医院2020年全部血培养病原菌阳性标本.采用BACT/ALERT 3D全自动微生物检测系统与配套培养瓶、VITEK2 Compact全自动微生物分析系统进行血液培养、病原菌鉴定及药敏试验.按CLSI 2018文件标准判定结果,Microsoft Excel 2010软件对数据进行整理、统计和分析.结果 2020年共收集血培养标本2 098份,分离病原菌246株,分离率11.73%.革兰阴性菌178株,以为大肠埃希菌、肺炎克雷伯菌为主;革兰阳性菌67株,以凝固酶阴性葡萄球菌、金黄色葡萄球菌为主;真菌1株,为马尔尼菲青霉菌.主要分布科室为呼吸与危重症医学科、重症医学科和消化内科.两种肠杆菌科细菌均对青霉素类药物(哌拉西林)耐药,但对多黏菌素E(PE)、替加环素(TGC)敏感率高达100%.MRSA和MRCNS的检出率分别为36.8%、71.2%,未发现葡萄球菌属对利奈唑胺(LNZ)、替加环素(TGC)和万古霉素(VAN)耐药.结论 该院血流感染病原菌种类相对较少,以革兰阴性菌为主,各临床科室间分布不一,不同病原菌间耐药率差异大.应加强对院内病原菌耐药性监测,以便指导临床合理用药.  相似文献   

9.
目的:观察床旁动脉血气分析应用于重症医学科的临床效果。方法资料选取本院2013年3月~2014年3月接收的66例ICU重症患者,随机分为对照组与研究组,对照组33例送至检验科检验,研究组33例予以床旁动脉血气分析,并分析两组患者血气分析用时、酸碱性指标与生理代谢指标检验结果相关情况。结果研究组患者血气分析检验用时与K+指标均明显优于对照组(P<0.05);两组患者血气分析其他各项酸碱性指标结果均无明显差异明显(P>0.05);两组患者血气分析各项生理代谢指标结果均无明显差异(P>0.05)。结论床旁动脉血气分析应用于重症医学科效果显著,可准确评价患者血钾水平,分析用时相对较少,具有实际应用价值。  相似文献   

10.
目的重症医学科染KPC-2肺炎克雷伯菌的耐药及同源性情况。方法从2018年4月至2019年2月于我院重症医学科室治疗的患者中提取40例耐碳青霉烯类肺炎克雷伯菌(CRKPN)菌株,对待测菌株进行药敏性试验、mCIM(改良碳青霉烯灭活试验)和eCIM(EDTA改良碳青霉烯灭活试验)联合试验,采用PCR扩增法检测待测菌的耐药基因并进行基因序列检测,采用PFGE对待测菌进行同源性分析。结果在16种抗菌药中,待测菌仅对阿米卡星(27.50%)、庆大霉素(17.50%)、妥布霉素(25.00%)、替加环素(100.00%)以及复方新诺明(55.00%)有敏感性;mCIM和eCIM试验结果显示40株CRKPN均产丝氨酸碳青霉烯酶;PCR试验结果显示待测菌株携带KPC基因阳性率为100%;选择ICU分离的17株CRKPN做PFGE,同源性结果分析显示该病区存在耐碳青霉烯肺炎克雷伯的克隆传播。结论我院重症医学科分离的CRKPN细菌的耐药机制是产丝氨酸碳青霉烯酶,酶基因为KPC-2型,PFGE结果分析显示我院重症医学科存在耐碳青霉烯肺炎克雷伯的克隆传播,需要加强院感监控工作。  相似文献   

11.
目的了解某院医院感染流行特征。方法连续3年采用横断面调查的形式调查该院住院患者,对调查日的所有住院患者的医院感染情况进行床旁调查和病历调查,统一填写调查表。结果 3年医院感染率为4.70%,医院感染例次率为5.01%。3年合计,各科室感染率前3位为重症医学科(35.00%)、层流病房(31.58%)、血液科(15.95%);感染部位构成比前3位为下呼吸道(47.43%)、泌尿道(15.81%)、血液系统(8.82%);病原体前3位为铜绿假单胞菌(13.90%)、大肠杆菌(11.23%)、金黄色葡萄球菌(9.63%)。结论医院感染的主要科室是重症医学科、层流病房、血液科,主要部位是呼吸道、泌尿道、血液系统,病原体以铜绿假单胞菌、大肠杆菌、金黄色葡萄球菌多见。  相似文献   

12.
韩焕菊 《医学信息》2019,(14):135-137
目的 分析2015~2017年住院时间超过30天患者基本信息,为医院对住院时间超过30天患者进行科学管理,缩短住院时间提供科学依据。方法 运用医院病案管理信息系统提取2015年1月1日~2017年12月31日住院时间超过3 d患者7061例的病案首页信息及《住院时间超过30天患者管理与评价报告表》,分析其性别构成、年龄、住院日、出院科室、ICD-10疾病名称的分布情况和住院时间超过30天的主要原因。结果 共7061例住院时间超过30天患者中,男性患者多于女性,62~81岁患者人数最多。住院时间31~60 d占比最高为91.72%,最长住院天数>211 d共19例患者,其中9例被家属遗弃,3例与我院有纠纷,3例与第三方有纠纷,4例为老干部公费医疗。有37.28%患者行手术治疗,62.72%患者给予非手术治疗。住院时间超30天患者科室排名前5位为血液内科、感染病科、放疗科、普外科、骨外科。主要诊断疾病为肿瘤;主要住院原因为疾病自身。结论 住院时间超过30天患者以男性、中老年为主,多分布于血液内科、感染病科、放疗科、普外科、骨外科,主要诊断疾病肿瘤,主要住院原因为疾病自身原因。加强对住院时间超过30天患者的管理,可有效缩短平均住院日,减轻患者及社会经济负担,对于提高医疗资源利用率具有重要意义。  相似文献   

13.
Collecting adequate volumes of blood in blood culture bottles is crucial for sensitive detection of bacteremia and fungemia. Tools enabling easy collection of data on the degree of blood culture bottle filling at different hospital departments are an important step toward quality measurement and improvement. In this study, we verified the accuracy of a software tool for the monitoring of blood culture bottle filling developed by Becton Dickinson, BD blood volume monitoring system (BVMS) that was adjusted for use on plastic BACTEC bottles, and evaluated its ease of use in routine practice. In total, 538 negative plastic BD BACTEC Plus Aerobic/F blood culture bottles collected in two secondary care hospitals in Belgium were included in the study. The BVMS software demonstrated good performance, with an acceptable mean difference of ??0.3 mL or ??4.0% between the mean volume estimated by BVMS and the mean weight-based volume. Data (mean blood volume and standard deviation) and figures (box-and-whisker and histogram plots) on blood culture bottle filling are easily acquired. They provide information on the current situation in a hospital (department) and can be used as a tool for quality improvement measurements and follow-up. Caution is required when interpreting BVMS results for hospital wards where a substantial amount of the bottles collected come from patients with hematocrit values <?30%. This study demonstrated that BVMS is a reliable and easy to use tool which facilitates monitoring and coordination of optimization of blood culture bottles filling by the clinical laboratory.  相似文献   

14.
目的 为进一步缩短实验室菌血症诊断时间,评估联合法阳性血培养直接鉴定药敏试验的可行性.方法 将血培养瓶放人BACTEC 9000血培养系统进行培养筛选.选取65份含革兰阴性杆菌的阳性血培养瓶进行试验.抽取培养液,用BD真空分离管离心分离血细胞.在收集到足量菌液后,用Phoenix 100 NMIC/ID-4革兰阴性菌鉴定药敏卡做0.25 McF和0.5 McF直接鉴定药敏试验.用标准方法及哑培养后的鉴定药敏试验对直接鉴定药敏试验进行评估.结果 0.25 McF直接鉴定试验,65株中的63株(96.9%)准确鉴定.0.5 MeF直接鉴定试验,65株中的59株(90.8%)准确鉴定.0.25 McF直接药敏试验标准符合率97.8%以上.0.5 McF直接药敏试验标准符合率95.9%以上.KB法血标本直接药敏试验标准符合率96.4%以上,但微小错误率高于联合药敏法.结论 采用0.25 McF、0.5 McF两种菌液浓度法进行血培养阳性标本鉴定药敏试验是切实可行的.联合法0.25 McF菌液浓度的直接鉴定药敏试验具有明显优势,对临床具有很好的及时、有效地指引作用.  相似文献   

15.
目的 为进一步缩短实验室菌血症诊断时间,评估联合法阳性血培养直接鉴定药敏试验的可行性.方法 将血培养瓶放人BACTEC 9000血培养系统进行培养筛选.选取65份含革兰阴性杆菌的阳性血培养瓶进行试验.抽取培养液,用BD真空分离管离心分离血细胞.在收集到足量菌液后,用Phoenix 100 NMIC/ID-4革兰阴性菌鉴定药敏卡做0.25 McF和0.5 McF直接鉴定药敏试验.用标准方法及哑培养后的鉴定药敏试验对直接鉴定药敏试验进行评估.结果 0.25 McF直接鉴定试验,65株中的63株(96.9%)准确鉴定.0.5 MeF直接鉴定试验,65株中的59株(90.8%)准确鉴定.0.25 McF直接药敏试验标准符合率97.8%以上.0.5 McF直接药敏试验标准符合率95.9%以上.KB法血标本直接药敏试验标准符合率96.4%以上,但微小错误率高于联合药敏法.结论 采用0.25 McF、0.5 McF两种菌液浓度法进行血培养阳性标本鉴定药敏试验是切实可行的.联合法0.25 McF菌液浓度的直接鉴定药敏试验具有明显优势,对临床具有很好的及时、有效地指引作用.
Abstract:
Objective To reduce the turnaround time for laboratory diagnosis of bacteremia, the feasibility of rapid identification and susceptibility testing using samples taken directly from positive blood culture bottles was evaluated. Methods The growth of microorganisms in blood culture bottles was screened by the BACTEC 9000 blood culture system. 65 positive blood culture bottles containing gram-negative bacteria were adopted to test. Culture fluid was injected into BD SST vacutainer and centrifuged to pellet blood cells. After collecting required McFarland units, they were cultured on Phoenix 100 NMIC/ID-4(identification-gram-negative bacteria and susceptibility testing) cards using 0.25 McF and 0.5 McF methods respectively. They were also evaluated by the standard method, involving subculture tests from positive blood culture bottles. Results 63 of 65 gram-negative bacteria (96. 9% ) were correctly identified with 0. 25 McF method. 59 of 65 gram-negative bacteria(90.8% ) were correctly identified with 0.5 McF method. For antimicrobial susceptibility testing, the 0.25 McF direct method had an agreement rate more than 94% , the 0.5 McF method was more than 85.7% and direct blood sample KB method was more than 93.8% compared to the standard method. But the overall minor error rate in susceptibility testing of direct blood sample KB method is higher than other methods. Conclusion Applying 0. 25 McF and 0. 5 McF rapid identification and susceptibility test was practical. During to possessing more prominent advantages, laboratory put the 0. 25 McF direct method into practice had a timely, remarkable significance.  相似文献   

16.
目的 为进一步缩短实验室菌血症诊断时间,评估联合法阳性血培养直接鉴定药敏试验的可行性.方法 将血培养瓶放人BACTEC 9000血培养系统进行培养筛选.选取65份含革兰阴性杆菌的阳性血培养瓶进行试验.抽取培养液,用BD真空分离管离心分离血细胞.在收集到足量菌液后,用Phoenix 100 NMIC/ID-4革兰阴性菌鉴定药敏卡做0.25 McF和0.5 McF直接鉴定药敏试验.用标准方法及哑培养后的鉴定药敏试验对直接鉴定药敏试验进行评估.结果 0.25 McF直接鉴定试验,65株中的63株(96.9%)准确鉴定.0.5 MeF直接鉴定试验,65株中的59株(90.8%)准确鉴定.0.25 McF直接药敏试验标准符合率97.8%以上.0.5 McF直接药敏试验标准符合率95.9%以上.KB法血标本直接药敏试验标准符合率96.4%以上,但微小错误率高于联合药敏法.结论 采用0.25 McF、0.5 McF两种菌液浓度法进行血培养阳性标本鉴定药敏试验是切实可行的.联合法0.25 McF菌液浓度的直接鉴定药敏试验具有明显优势,对临床具有很好的及时、有效地指引作用.  相似文献   

17.
BacT/Alert FAN blood culture bottles have been shown to enhance the recovery of bacteria and yeast from blood compared with standard BacT/Alert bottles. It is well established that standard BacT/Alert blood culture bottles require no more than 5 days of incubation for the detection of routine bacteria and yeast. It is less clear, however, whether FAN bottles also routinely require 5 days of incubation. To address this question, we recently reviewed the results of 17,887 blood culture sets collected in FAN blood culture bottles at Geisinger Medical Center. Of these cultures, 1,780 were positive for bacteria or yeast, yielding a total of 1,242 clinically significant isolates. The numbers of isolates recovered on days 1, 2, 3, 4, and 5 were as follows: (values in parentheses are percentages of total significant isolates): 877 (71%), 269 (22%), 65 (5%), 18 (1%) and, 13 (1%), respectively. In total, 97.5% of all clinically significant isolates were detected in the first 3 days of incubation. Of the 31 significant isolates detected on day 4 or 5 of incubation, 17 were detected in concurrent blood cultures within the first 3 days of incubation. Chart reviews were conducted for the 13 patients with the remaining 14 isolates detected on day 4 or 5 to determine whether therapy was changed due to this blood culture result. Therapy was changed for only 1 patient. These results suggest that it may not be necessary to routinely incubate FAN blood culture bottles for more than 3 days.  相似文献   

18.
In a coordinated, double-blind multi-centre trial, adults with symptoms of acute pyelonephritis were randomly assigned to receive a two-week course of oral treatment with either 400 mg norfloxacin twice daily or 1 g cefadroxil twice daily. Of 197 patients enrolled in the study, 140 could be evaluated for drug efficacy and 193 for drug safety. Norfloxacin gave a significantly higher bacteriological cure rate than cefadroxil, both at 3 to 10 days (98 % versus 65 %; p<0.0001; 95 % confidence interval (CI) for difference in proportions 21–46 %) and up to eight weeks (87 % versus 48 %; p<0.0001; 95 % CI 25–54 %) after cessation of treatment. The differences between the two regimens were most pronounced in men and in patients with complicating factors such as diabetes mellitus and urinary tract abnormalities. The clinical response during treatment did not differ between the two groups, but symptomatic recurrences at follow-up were more common in the cefadroxil group (28 % versus 3 %; p<0.0001; 95 % CI 14–36 %). Adverse events were more often reported by patients receiving cefadroxil (39 % versus 22 %; p=0.011; 95 % CI 4–30 %) and consisted mainly of gastrointestinal disturbances and vulvo-vaginitis. In terms of bacteriological and clinical efficacy and safety, a two-week course of norfloxacin was superior to a two-week course of cefadroxil for oral treatment of community-acquired acute pyelonephritis.Investigators: Dr G. Lekås, Department of Infectious Diseases, Central Hospital, Gävle; Dr V. Friman and Dr T. Sandberg, Department of Infectious Diseases, Östra Hospital, Göteborg; Dr H. Montelius and Dr R. Neringer, Department of Infectious Diseases, Central Hospital, Karlskrona; Dr S.-E. Lundin and Dr O. Wik, Department of Infectious Diseases, Central Hospital, Karlstadt, Dr C. Franzén, Department of Infectious Diseases, Central Hospital, Sundsvall; Dr M. Hebelka, Department of Infectious Diseases, Central Hospital, Uddevalla, Sweden.  相似文献   

19.
Emergency departments (EDs) are an important diagnostic site for outpatients with potentially serious infections. EDs frequently experience high patient volumes, and crowding has been shown to negatively impact the delivery of early care for serious infections, such as pneumonia. Here, we hypothesized that other important factors in the early care of infectious diseases, the rate of blood culture contamination and the accurate detection of pathogens, would be sensitive to ED operational stress, as proper collection requires fastidious attention to technique and timing. We related all blood samples collected over 1 year and their rates of recovery of likely contaminants and pathogens to the number of patients being cared for in the ED at the time of sample collection. Likely pathogens and contaminants were classified through combined microbiological and manual chart review criteria. Zero-inflated Poisson regression was used to relate crowding to culture results. Blood samples were obtained from 7,586 patients over 82,521 adult and pediatric patient visits. The unadjusted rates of recovering a likely pathogen or a likely contaminant were 8.0% and 3.7%, respectively. Periods of increased crowding (3rd and 4th quartiles of hourly occupancy) were significantly associated (P < 0.01) with increased rates of contamination (relative risk, 1.23 compared to the least busy quartile). Collecting samples for culture during busy times was also associated with a reduced likelihood of recovering a likely pathogen (relative risk, 0.93 compared to the least busy quartile). ED crowding was associated with degraded performance of blood cultures, both increasing the rate of contamination and decreasing the diagnostic yield.  相似文献   

20.
Fluorescence in situ hybridization (FISH) using peptide nucleic acid (PNA) probes targeting Staphylococcus aureus 16S rRNA is a novel method for direct identification of S. aureus from positive blood culture bottles. The test (S. aureus PNA FISH) is performed on smears made directly from positive blood culture bottles with gram-positive cocci in clusters (GPCC) and provides results within 2.5 h. A blinded comparison of S. aureus PNA FISH with standard identification methods was performed in collaboration with eight clinical microbiology laboratories. A total of 564 routine blood culture bottles positive for GPCC recovered from both aerobic and anaerobic media from three different manufacturers (ESP, BACTEC, and BacT/Alert) were included in the study. The sensitivity and specificity of S. aureus PNA FISH were 100% (57 of 57) and 99.2% (116 of 117), respectively, with 174 GPCC-positive ESP blood culture bottles, 98.5% (67 of 68) and 98.5% (129 of 131), respectively, with 200 GPCC-positive BACTEC blood culture bottles, and 100% (74 of 74) and 99.1% (115 of 116), respectively, with 190 GPCC-positive BacT/Alert blood culture bottles. It is concluded that S. aureus PNA FISH performs well with commonly used continuously monitoring blood culture systems.  相似文献   

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