BacT/Alert 240全自动血培养仪的临床应用及评价

目的：评价全自动血培养仪BacT/Alert 240的临床应用情况，方法：回顾性分析BacT/Alert240全自动血培养系统检测7124份标本的阳性率，阳性检出时间，细菌种类以及假阳性率，假阴性率和污染率，结果：7124份血培养分离到804株微生物，其中细菌764株，阳性率11．5％，最快阳性检出时间2小时，24小时内检出的阳性占69．9％，48小时内占87．3％，72小时内占91．3％，804株细菌分布于24个属，假阳性率4．9％，假阴性率0．4％，污染率0．3％，结论：BacT/Alert 240全自动血培养仪提高了血培养的阳性率，缩短了阳性检出时间，检出细菌种类多尤其是苛养菌阳性率增加，减少污染机会，而且操作简便，结果快速，准确。     

Hub qualitative blood culture is useful for diagnosis of catheter-related infections in critically ill patients

Objective To assess clinical safety and accuracy of qualitative blood culture drawn through the hub for ruling out catheter-related infection (CRI).Design and setting Prospective observational study in a surgical intensive care unit.Patients All patients with sepsis of unknown origin and possibly due to a CRI.Interventions Blood culture drawn through a central venous catheter (CVC) just before the catheter was cultured.Measurements and results In 126 patients we investigated 135 cases of sepsis of unknown origin. Using a clinical and bacteriological approach as the reference, the performance of the CVC blood culture was evaluated by the calculation of sensitivity, specificity, and positive and negative predictive values. When CVC blood culture was positive, the time to positivity was considered. Using standard definitions, seven CRIs were diagnosed. CVC blood culture identified five CRIs including the three episodes of catheter-related bacteremia. The method missed two coagulase-negative staphylococcus CRIs without bacteremia. Thirteen false-positive results occurred, including seven bacteremias from a distant source. The CVC blood culture had a sensitivity of 71% (CI 30–95%), specificity of 90% (CI 83–94%), negative predictive value of 98% (CI 93–100%), and positive predictive value of 28% (CI 11–54%). In cases of catheter-related bacteremia the time to positivity of CVC blood culture was 24 h or less.Conclusions Negative CVC blood culture at 24 h seems useful for management of CVC in selected critically ill surgical patients developing a clinical sepsis. The subsequent risk of catheter-related bacteremia cannot be excluded advocating for an uninterrupted clinical and bacteriological survey.     

404例血培养阳性报警时间分析

目的：分析不同细菌在全自动血培养仪（BacT／Alert3D）中的血培养阳性报警时间（TTP,timeto—positivityofbloodculture）及其意义。方法：回顾性分析微生物实验室在2010年1月至2012年12月期间接收的7688瓶血培养标本,对404例阳性结果的阳性报警时间进行统计分析。结果：404例阳性分离株中,肠杆菌科细菌、肠球菌、非发酵菌、链球菌、葡萄球菌、假丝酵母菌和厌氧菌阳性报警时间中位数依次是：11．7h、13．3h、15．2h、16．8h、23．5h、29．6h和48h。90．6％的标本在48小时内即出现阳性报警。结论：大部分阳性分离茵可在全自动血培养仪（BacT／Alert3D）48小时内检出,阳性报警的快慢因菌种不同而存在差异。     

Bactec FX和Bact/Alert 3D两种血培养系统对菌血症的检出性能分析

目的对比分析Bactec FX血培养系统Bactec Plus树脂需氧瓶(简称BO-P瓶)和Bact/Alert 3D全自动血培养系统SA标准瓶(简称Bio-SA瓶)/SN厌氧瓶(简称Bio-SN瓶)对菌血症的检出能力及特点,探讨提高血培养阳性率、快速准确地作出病原学诊断的方法。方法从双侧部位抽取患者的静脉血,一侧注入BO-P瓶,另一侧注入Bio-SA瓶和Bio-SN瓶,置于相应培养系统培养,比较这3种血培养瓶的阳性率及检出时间。结果 6 188份标本中确认阳性765份(12.36%);确认污染134份(2.17%);假阳性11份(0.18%)。332株临床分离菌中BO-P瓶检出293例,占88.25%;Bio-SA瓶检出271例,占81.63%,前者阳性率高于后者(χ2=5.687,P<0.05);Bio-SN瓶检出201例,占60.54%,其中厌氧菌3例,占0.90%。与Bio-SA瓶相比,BO-P瓶检出阳性的时间优于Bio-SA瓶(P<0.05),尤其是对非发酵菌。污染菌以革兰阳性菌为主(89.55%),主要是凝固酶阴性的葡萄球菌(67.91%),少部分革兰阴性杆菌(9.7%)。结论双侧抽血并联合使用Bactec FX和Bact/Alert 3D血培养系统可利用各自优势,更有效地提高血培养阳性率。     

Evaluation of the alkaline wash/lysis procedure for the molecular diagnosis of a positive bacterial blood culture in clinical routine practice

Blood culture is commonly used to detect microorganisms in patients with a suspected blood infection. This study evaluated the alkaline wash/lysis procedure to extract DNA of microorganisms in a clinical blood culture. A multiplex polymerase chain reaction (PCR) targeting the 16S rDNA (ribosomal DNA) gene and the fungal ITS (internal transcribed spacer) gene was used as a reliable indicator for the presence of microorganism DNA in the extracts. A total of 535BacT/ALERT positive blood culture bottles were evaluated. Multiplex PCR showed positive results in 530 DNA extracts, but 5 DNA extracts gave negative results. We conclude that the alkaline wash/lysis procedure in combination with the multiplex PCR is a simple and sensitive method, which can be used in a standard diagnostic laboratory to detect microorganisms in blood culture material. J. Clin. Lab. Anal. 24:139–144, 2010. © 2010 Wiley‐Liss, Inc.     

The management of hyperleukocytosis in 2017: Do we still need leukapheresis?

Hyperleukocytosis is defined as a white blood cell count greater than 100.000/μL in patients affected by acute or chronic leukemias. Hyperleukocytosis is more common in acute leukemias than in chronic leukemias. Risk factors include younger age, acute myeloid leukemia, the microgranular variant of acute promyelocytic leukemia, acute lymphoblastic leukemia and some cytogenetic abnormalities. Although it can affect any organ system, symptoms usually arise from involvement of the cerebral, pulmonary and renal microvasculature. The term “leukostasis” refers to ‘symptomatic hyperleukocytosis’ which is a medical emergency that needs prompt recognition and initiation of therapy to prevent renal and respiratory failure or intracranial haemorrhage. The underlying mechanisms of hyperleukocytosis and leukostasis are poorly understood. The management of hyperleukocytosis and leukostasis involves supportive measures and reducing the number of circulating leukemic blast cells by induction chemotherapy, hydroxyurea, low-dose chemotherapy, and leukapheresis. The measures such as hydroxyurea, low-dose chemotherapy, and leukapheresis shouldn’t be considered to correct the laboratory abnormalities in patients with hyperleukocytosis who have no signs or symptoms. Also, neither hydroxyurea nore leukapheresis is able to show benefit on short and long term outcomes in patients with symptomatic hyperleukocytosis. The optimal management of symptomatic hyperleukocytosis is still uncertain, and there are no randomized studies demonstrating one is superior to each other. Therefore, it is recommended that intensive chemotherapy should be implemented as quickly as possible in treatment-eligible patients, in parallel with supportive measures for DIC and TLS.     

Blood culture examinations at a community hospital without a microbiology laboratory: using an automated blood culture system and performing a Gram stain on positive culture bottles in the institution

To elucidate the existence of microorganisms from blood culture bottles in hospitals without a microbiology laboratory, we changed the system of blood culture examinations. The Oxoid signal blood culture system and submission of all blood cultures to the clinical testing industry was used from July 2002 to December 2002 (first period). Use of the BacT/Alert system and performing of Gram stain for positive culture bottles in our institutions was conducted from January 2003 to June 2003 (latter period). A total of 210 and 193 blood cultures were processed during the first and latter periods, respectively. There were 40 (19.0%) positive cultures in the first period and 32 (16.6%) positive cultures in the latter period. The times from the specimen collection to the Gram stain result that were required were 3.8 and 1.0 days in the first period and the latter period, respectively. The times required for the final report of the blood cultures in the first period and in the latter period were 5.8 and 4.9 days, respectively. We conclude that using a continuous monitoring, automated blood culture system and performing Gram stain for positive culture bottles in institutions without microbiology laboratories may be useful for medical doctors to rapidly determine the existence of microorganisms and to begin adequate antiinfective therapy.     

血涂片分类检出白血病研究

目的强调全血细胞分析仪使用仍然需要进行血涂片镜检分析的重要性。方法采用全血细胞分析仪与血涂片镜检进行白血病细胞检查。结果检出白血病30例，其中27例与骨髓诊断一致，另3例未查骨髓（因患者拒查），但治疗后有缓解。结论血涂片分类可发现慢性粒细胞白血病、慢性淋巴细胞白血病、急性淋巴细胞白血病、急性非淋巴细胞白血病M1、M3和M7型等。用血细胞分析仪分析血液时，不能忽视血细胞形态学镜检，以防止白血病漏诊。     

Comparison of the BACTEC blood culture system versus conventional methods for culture of normally sterile body fluids

This study compared the BACTEC™ blood culture system (Becton Dickinson Diagnostic Instrument Systems, Sparks, Md) with conventional culture methods for recovery and time to detection of significant isolates from normally sterile body fluids. A total of 412 specimens were included in the study. Half of the specimens were inoculated directly into the automated blood culture system. The remaining specimens were centrifuged at 3000 rpm for 10 min and were inoculated onto conventional media. Clinically significant microorganisms were isolated from 41 specimens (10%) by both culture systems; however, for 62 specimens (14.9%), growth was detected only with the BACTEC system. No isolates were detected with only conventional culture methods. A significant difference was noted between the blood culture system and routine culture methods for recovery of pathogenic microorganisms that were from sterile body fluids. The most frequently isolated microorganisms recovered only with the blood culture system were gram-positive cocci; gram-negative bacilli were the most frequently isolated microorganisms that were recovered with both culture methods.Streptococcus pneumoniae, Streptococcus viridans,Aeromonas hydrophila, andBrucella were recovered only with the blood culture system. Furthermore, the mean time to detection of significant pathogens was significantly less with the blood culture system than with conventional media. The BACTEC blood culture system was found to improve the yield of clinically significant isolates from normally sterile body fluids with reduced time to detection; it may be advantageous for isolation of fastidious microorganisms, such asBrucella andS pneumoniae, especially from cerebrospinal and synovial fluid specimens.     

血细胞分析仪白细胞分类异常警句分析及临床应用的评价

目的 探讨血细胞分析仪异常警句在临床应用的价值。方法 对201例静脉血临床诊断明确的病例标本，用全自动血细胞分析仪分类出现异常警句提示与人工镜检白细胞分类结果分析。结果 淋巴细胞白血病，单核细胞白血病，粒细胞白血病患者阳性符合率分别可达81．8％，75％，85．7％。结论 血细胞五分类结果较人工分类更快更全面，但检验人员应结合临床诊断观察仪器的异常细胞警句提示，必要时应做人工镜检，这对防止实验室使用仪器分类计数漏检异常细胞有很好的辅助作用。     

Delayed insertion of blood culture bottles into automated continuously monitoring blood culture systems increases the time from blood sample collection to the detection of microorganisms in bacteremic patients

This study examined the effects on patients with bacteremia of delaying the insertion of a blood culture bottle into an automated, continuously monitoring blood culture system. We investigated the time taken from the collection of blood samples (collection) to the insertion of blood culture bottles inoculated with blood samples into the instrument (insertion), and compared the mean detection time from collection to a positive signal from the instrument with the time between collection and insertion. The study was conducted from January 2003 to December 2004 at Kyoto University Hospital. Insertion into the system on the day of blood sample collection was defined as same-day insertion, and insertion on a different day to collection was defined as delayed insertion. The 7394 aerobic and anaerobic blood culture bottle sets obtained during the study period included 4361 sets with same-day insertion and 3033 sets with delayed insertion. For same-day insertion, 458 microorganisms were isolated from 432 positive sets in which at least one blood culture bottle was positive. For delayed insertion, 405 microorganisms were isolated from 379 positive sets in which at least one blood culture bottle was positive. The mean detection time for all microorganisms was significantly earlier for same-day insertion than for delayed insertion (28.3 h vs. 45.0 h, respectively, P < 0.0001). Delays from collection to insertion affect the time from collection to the detection of microorganisms.     

80株深部真菌感染阳性血培养及药敏结果分析

目的　分析 80株血培养真菌阳性标本及其药敏结果 ,寻找深部真菌感染特点。方法　血培养使用Back/Alert血培养仪。分离使用科玛嘉培养基。真菌和细菌鉴定使用VitekAMS 6 0微生物分析仪。药敏使用微量MIC法。HCMV检验使用PCR和RT PCR方法。结果　 80株真菌分布在 4个菌属中 ,以念珠菌属为主占 91 2 5%。获得阳性结果时间平均 31 80h ,72h内获得结果者 76株占 95 0 %。对 5种真菌作药敏试验 ,5 氟胞嘧啶敏感率最高 ( 97% ) ,特比奈芬最低 ( 35% )。 51 2 5%( 4 1 /80 )患者从血以外的其他标本获得与血中分离菌种一致的真菌。 80例患者中 4 6例伴随有细菌或病毒感染 ,占患者57 50 %。真菌感染多见于免疫功能低下者 ,本组 80例患者中各种肿瘤占 6 9例 ( 86 2 5% )。结论　血培养阳性是患者深部真菌感染的确证依据 ,多为在免疫功能低下者发生的院内感染 ,多系统真菌感染多为临床致死原因。真菌药敏实验结果给临床治疗提供了有参考价值的信息     

cdx2基因在儿童白血病的表达及临床意义研究

本研究旨在探讨cdx2基因在儿童急性白血病骨髓及外周血单个核细胞中的表达及临床意义。采取33例初发儿童白血病患儿骨髓及外周血,运用RT-PCR方法检测cdx2基因在各型白血病及正常对照组中的表达,随访25例并观察其与疗效的关系。结果发现,病例组中30例急性白血病(AL)患儿cdx2表达阳性25例(83.3%),30例中21例急性淋巴细胞白血病(ALL)和9例急性髓细胞白血病(AML)cdx2表达阳性分别为20例(95.2%)和5例(55.6%),两组相比有统计学意义(p<0.05);3例慢性粒细胞白血病(CML)中1例cdx2表达阳性。对照组20例健康体检者外周血cdx2表达阴性,与病例组比较差异有统计学意义(p<0.01)。25例AL患儿cdx2阳性21例(ALL17例,AML4例)与阴性者4例(ALL1例,AML3例)经治疗后均达到完全缓解(CR)。cdx2是否阳性表达可能与CR率无相关关系。对8例cdx2表达阳性AL患儿治疗后动态观察,结果初诊cdx2阳性表达在CR时仍阳性,但随着CR延长cdx2表达逐渐转为阴性,而初诊时cdx2阴性表达在骨髓CR时仍为阴性。结论:cdx2在儿童AL患者中广泛高表达,ALL者该基因表达阳性率高于AML患儿。CML患儿中也有cdx2表达;cdx2基因表达与AL患者CR率无明显相关。     

355例留置导尿管尿培养阳性结果分析

目的：探讨留置导尿管尿培养阳性结果在尿路感染中的意义。方法回顾性分析我院2012年1月至12月355例留置导尿管住院患者尿培养阳性结果的符合率，以减少此类标本的假阳性率。结果我院留置导尿管尿培养阳性占尿培养阳性结果的47.81%，留置导尿管尿病原菌分布以单一细菌为主，主要为G-杆菌59.15%；其次是肠球菌17.75%；较少的是念珠菌5.35%、葡萄球菌3.10%和其它链球菌占1.13%，混合菌占13.52%。210例中G-杆菌有49例（23.33%）为假阳性；培养出两种细菌（48例）和肠球菌（63例）的假阳性率分别高达56.25%和63.49%；念珠菌（19例）、除金黄色葡萄球菌外的葡萄球菌（11例）及除化脓性链球菌外的其他链球菌（4例）的假阳性率甚至高达70%以上。结论当留置导尿管尿培养实验室检出阳性时，特别是培养生长阳性球菌、念球菌以及多种细菌生长均达到致病菌量生长标准时，应加强临床沟通，结合患者临床症状，判断是否为致病菌。     

儿童急性髓系白血病临床研究

目的：了解儿童急性髓系白血病的临床特点、治疗疗效及预后因素。方法：对１９７８年８月～１９９５年１２月２７４例儿童急性髓系白血病进行临床总结和分析。结果和结论：中位确诊年龄７岁３个月，男∶女＝１．６３∶１，Ｍ２、Ｍ３型占８０％，高白细胞血症２０例，髓外白血病２４例，有Ａｕｅｒ小体者占３２．９％。治疗２４４例，分别以三种方案进行治疗，完全缓解（ＣＲ）率５５．８８％～９２．３１％，证明采用ＤＡ或ＤＡ＋Ｖｍ２６或Ｖｐ１６是提高ＣＲ的关键。影响诱导缓解因素为病初白细胞计数和肝脾肿大程度。通过ＳＰＳＳ统计学软件分析，ＡＭＬ亚型、Ａｕｅｒ小体、诱导缓解时间、髓外白血病等因素对远期预后有影响。     

血培养联合降钙素原和 C-反应蛋白在对急性感染性发热患者诊断中的应用价值

目的：探讨血培养联合降钙素原和 C-反应蛋白检测在急诊感染性发热患者诊断中的应用价值。方法回顾性分析本院急诊科126例血培养阳性急性发热患者及123例血培养阴性急性发热患者采血当日 CRP 和 PCT 测定结果,并对两组数据进行比较,数据采用 SPSS 16．0软件进行统计分析。结果126例血培养阳性患者 CRP 和 PCT 的阳性率分别为100．0％和100．0％,测定值为26．9～256．8和0．25～98．6;123例血培养阴性患者 CRP 和 PCT 的阳性率为95．5％和15．4％,测定值为1．2～126．8和0．02～0．98。血培养阳性组 PCT 测定值明显高于血培养阴性组,差异有统计学意义（P ＜0．01）,血培养阳性组CRP 测定值明显高于血培养阴性组,差异有统计学意义（P ＜0．01）。结论PCT 与 CRP 可作为血流感染的监测指标,血培养联合 PCT 和 CRP 对细菌感染的早期诊断有指导意义。     

实行血培养阳性危机值报告制度监督血培养全程质量控制

目的 实行血培养阳性危机值(critical value)报告制度监督血培养全程质量控制(TQC),提高血培养阳性率,快速、准确地作出病原学诊断.方法 血培养及鉴定采用美国BD9050全自动血培养仪和法国生物梅里埃公司ATBExpression自动细菌鉴定仪.结果 在2 700例血培养中阳性共326例,其中4例为污染菌,污染率为1.2%;322例为病原菌,阳性率为12%.结论 实行血培养阳性危机值报告制度使微生物检验人员、临床医生和护理人员及时沟通,减少污染率,实现血培养全程质量控制.     

Myocardial Infarction and Stroke as the Presenting Symptoms of Acute Myeloid Leukemia

Background: Hyperleukocytosis in acute leukemia is associated with lymphadenopathy, hepatosplenomegaly, disseminated intravascular coagulation, and central nervous system complications. Patients with hyperleukocytosis have lower complete remission rates and have a higher mortality rate, primarily from intracranial hemorrhage. Objectives: To present the potential complications from extreme leukocytosis. Case Report: A 76-year-old man presented to the Emergency Department with chest pain, right-sided weakness, and decreased responsiveness. He was diagnosed with both an acute stroke and myocardial infarction due to extreme leukocytosis from acute myeloid leukemia. Each of these complications by itself would be an unusual manifestation of hyperleukocytosis. To the best of the author's knowledge, this represents the first reported case of these two complications simultaneously from extreme leukocytosis. Conclusions: Patients with acute leukemia may present with hyperleukocytosis, which may result in decreased tissue perfusion. Ischemia occurring in the heart can lead to an acute myocardial infarction, whereas ischemia in the brain can lead to a stroke. These events may, on occasion, be the initial presentation of leukemia. Rapid identification and treatment of the hyperleukocytosis may prevent these complications.     

The management of hyperleukocytosis in an adult patient with acute lymphoblastic leukemia and ataxia-telangiectasia

Ataxia-telangiectasia (AT) is a hereditary disorder characterized by progressive neurological dysfunction, oculocutaneous telangiectasia, immunodeficiency, cancer susceptibility, and radiation sensitivity. Pediatric patients may develop acute lymphoblastic leukemia (ALL). However development of ALL in an adult patient with AT is a rare occurrence. Here we report such a patient who presented with hyperleukocytosis and were treated with leukapheresis. A 25 years old male patient, who were diagnosed with AT and mental retardation, was admitted to the emergency department due to fatigue, nausea and headache. On admission he had a moderate general condition and was fully cooperated. His white blood cell (WBC) count were 466 × 10⁹/l. Blastic cells were observed in peripheral blood smear. Flow cytometry (FC) of peripheral blood showed T-ALL. Two sessions of large volume leukapheresis was performed. Symptoms due to hyperleukocytosis markedly improved after leukapheresis. Patients with AT should be closely monitored due to risk of malignancy. Leukapheresis may improve the prognosis of high risk ALL patients presenting with hyperleukocytosis.     

急性白血病患者HLA半倍相合骨髓移植后供者源复发2例

为了探讨半倍相合骨髓移植后急性白血病患者的复发情况，对2例接受半倍相合骨髓移植后出现白血病复发的急性白血病患者进行了外周血、骨髓检查、骨髓细胞形态观察及HLA基因型和染色体核型分析。结果发现。2例原发病分别为急性淋巴细胞白血病（普通细胞型）和急性巨核细胞白血病，且2例白血病细胞均有染色体畸变或癌基因突变、活化，2例骨髓移植后完全供者源造血重建，但2例复发后白血病细胞均来源于供者源，血型和HLA分型均为供者型，复发后2例诊断为急性淋巴细胞白血病（B细胞型）和急性巨核细胞白血病。这一结果提示，供者源复发可能与移植后应用大剂量免疫抑制剂有关，化疗、放疗以及受者本身造血微环境异常也可能参与了二次白血病的发生过程。异基因造血干细胞移植后供者源复发可能是研究人白血病发生的适宜模式。