Guidewire catheter exchange with triple culture technique in the management of catheter sepsis

We report 70 total parenteral nutrition (TPN) patients who received guidewire catheter exchange for suspected sepsis during their hospitalization. To diagnose catheter-related sepsis (CRS) and catheter infection (CI), we used a system of pre- and postexchange catheter blood cultures and a catheter tip culture. There were 27 catheter exchanges with positive cultures. The rate of definite CRS/CI (eight instances) was 6.8% of catheters exchanged and 3.5% of all catheters at risk. Probable CRS/CI (11 instances) was seen in 9% of exchanged catheters and 5% of at risk catheters. Thus, 19/27 positive cultures were presumed to represent definite or probable CRS/CI. Coagulase negative Staphylococcus (SCN) was the most frequently isolated organism. Simple catheter exchange was usually effective treatment of CRS/CI when SCN was the offending organism. The salvage rate of catheters exchanged for suspected sepsis or after a positive blood culture was 84%. Only 7% of exchanged catheters had to be removed. Guidewire exchange with triple culture technique was without mechanical complications. We recommend this technique to monitor central venous catheters in patients receiving TPN since it is simple, essentially painless to perform, and easily interpreted.     

Nosocomial bacteremia: clinical significance of a single blood culture positive for coagulase-negative staphylococci.

OBJECTIVES: To describe the epidemiology of nosocomial coagulase-negative staphylococci (CoNS) bacteremia and to evaluate the clinical significance of a single blood culture positive for CoNS. DESIGN: A 3-year retrospective cohort study based on data prospectively collected through hospital-wide surveillance. Bacteremia was defined according to CDC criteria, except that a single blood culture growing CoNS was not systematically considered as a contaminant. All clinically significant blood cultures positive for CoNS nosocomial bacteremia were considered for analysis. SETTING: A large university teaching hospital in Geneva, Switzerland. RESULTS: A total of 2,660 positive blood cultures were identified. Of these, 1,108 (41.7%) were nosocomial; CoNS were recovered from 411 nosocomial episodes (37.1%). Two hundred thirty-four episodes of CoNS bacteremia in the presence of signs of sepsis were considered clinically relevant and analyzed. Crude mortality and associated mortality were 24.4% and 12.8%, respectively. Associated mortality was similar among patients with one positive blood culture and those with two or more (16.2% vs 10.8%, respectively; P = .3). Mortality rates after bacteremia for patients with a single positive blood culture and for those with two or more were 15.3% and 7.0%, respectively, at day 14 (RR, 2.2; CI95, 0.87-5.46) and 20.8% and 11.3%, respectively, at day 28 (RR, 1.9; CI95, 0.9-3.8). On multivariate analysis, only age and a rapidly fatal disease were independently associated with death. CONCLUSION: CoNS bacteremia harbor a significant mortality and a single positive blood culture in the presence of signs of sepsis should be considered as clinically relevant.     

Skin antisepsis kits containing alcohol and chlorhexidine gluconate or tincture of iodine are associated with low rates of blood culture contamination.

OBJECTIVE: Skin preparation is an important factor in reducing the rate of blood culture contamination. We assessed blood culture contamination rates associated with the use of skin antisepsis kits containing either 2% alcoholic chlorhexidine gluconate or 2% alcoholic tincture of iodine. DESIGN: Prospective, blinded clinical trial. SETTING: Tertiary-care teaching hospital. PATIENTS: Adult patients in medical wards, the medical intensive care unit, and the cardiac intensive care unit who needed paired, percutaneous blood cultures. INTERVENTIONS: House officers, medical students, and healthcare technicians drew the blood for cultures. We prepared sacks containing all of the necessary supplies, including two different types of antiseptic kits. In each sack, one kit contained 2% chlorhexidine in 70% isopropyl alcohol and the other contained 2% tincture of iodine in ethyl alcohol and 70% isopropyl alcohol. Each patient received chlorhexidine at one site and tincture of iodine at the other. RESULTS: Four (0.9%) of 430 blood culture sets from 215 patients were contaminated. The contamination rate when using alcohol and chlorhexidine (1 of 215, 0.5%) did not differ significantly from the contamination rate when using tincture of iodine (3 of 215, 1.4%; P = .62, McNemar test). There was an 87% probability that the two interventions differed by less than 2% in their rate of contamination. CONCLUSIONS: Both of these antiseptic kits were highly effective for skin preparation prior to drawing blood for cultures. The use of these kits may have contributed to the low contamination rate observed in this study.     

The use of bone marrow culture for the diagnosis of melioidosis

We have evaluated prospectively the contribution of bone marrow culture to the diagnosis of melioidosis. Bone marrow (BMC) and blood cultures (BC) were collected concurrently from 105 patients with suspected acute, severe melioidosis. 67 patients were subsequently proved to have the disease whilst other significant organisms were isolated from these specimens in 5 cases. Overall, 67.2% of BC and 64.2% of BMC from melioidosis patients grew Pseudomonas pseudomallei. Time to positivity did not differ significantly in paired BC and BMC specimens. These results do not support the routine use of BMC in the diagnosis of acute, severe melioidosis. In one patient with pulmonary melioidosis, however, blood cultures were repeatedly negative, whilst bone marrow grew P. pseudomallei, and this preceded the development of a distant focus of infection. This suggests that culture of bone-marrow may be of value in certain blood culture-negative patients with melioidosis.     

Semiquantitative culture of subcutaneous segment for conservative diagnosis of intravascular catheter-related infection

BACKGROUND: Sensitivity and negative predictive values of combined surface cultures (skin and hub) are high in the presumptive diagnosis of catheter-related infection, but specificity and PPVs are poor. The purpose of the study was to evaluate the yield of the semiquantitative culture of the subcutaneous segment in the diagnosis of colonization of the catheter tip without removal of the catheter. METHODS: A prospective study was performed in 124 nontunneled central venous catheters that were removed because of suspected infection or the end of therapy. Catheter colonization was considered if >15 colony-forming units (CFU) in the roll procedure or > 1,000 CFU in the quantitative Cleri procedure were recovered from the tip cultures ("gold standard"). Before removing the catheter, a semiquantitative culture of skin surrounding the point of insertion, a semiquantitative culture of the subcutaneous segment (after removing the catheter only 2 cm), a semiquantitative cultures of the hub, and a pareated quantitative blood culture were performed. Receiver operating characteristic curves were calculated to estimate the cutoff points, and a culture was considered positive when CFUs were > or =15, > or =15, and > or =5 for skin, hub, and subcutaneous segment cultures, respectively. RESULTS: Catheter colonization was detected in 51 catheters. The mean duration of catheterization was 14 +/- 8 days, and the rates of incidence of tip colonization and bacteremia were 2.9 per 100 catheter days and 1.2 per 100 catheter days, respectively. Sensitivity of skin, subcutaneous, and hub cultures analyzed individually were < or =61%; however, specificity and positive predictive values (PPVs) of subcutaneous segment cultures were significantly higher than skin cultures (94% and 88.5% vs 71.6% (p = .001) and 62% (p = .014), respectively). Sensitivity of the combined skin and hub cultures and of the combined subcutaneous segment and hub cultures were similar: 86.2% and 84.3%, respectively; however, specificity and PPVs of this latter combination were significantly higher than former: 82% and 78.1% vs 59.7% (p = .008) and 61.9% (p = .07), respectively. The likelihood ratio of a positive test for the combined subcutaneous segment and hub culture was 4.68, and only 2.13 for the combined skin and hub culture. CONCLUSIONS: These results indicate that the combined subcutaneous segment and hub culture constitutes an easy, effective procedure for the conservative diagnosis of catheter colonization.     

Chloramphenicol drug failure in typhoid fever

Two hundred positive blood culture typhoid patients admitted to Embaba Fever Hospital, Giza province, were subjected to: 1) Careful history and thorough clinical examination. 2) Complete blood picture. 3) Widal agglutination test. 4) Urine and stool cultures for Salmonellae. 5) To the isolates of the cultures, disk diffusion chloramphenicol susceptibility test, minimum inhibitory concentrations and chloramphenicol acetyl transferase test were performed. The dose of chloramphenicol was restricted to 50 mg per Kg body weight daily, whatever the route used; whether oral, rectal or intravenous. When fever did not drop up to 5 days or the patient presented with typhoid complications or the blood culture revealed resistant Salmonellae, quinolones or third generation, cephalosporins were administered. Measurement of the level of chloramphenicol in the blood was performed for every patient. Fifty (25%) patients were found to be resistant in vitro and in vivo to chloramphenicol. All their Salmonellae isolates were resistant to chloramphenicol, the mean zone size was 10 mm, the mean inhibitory concentration was 64 microgram per ml. and all were positive for chloramphenicol acetyl transferase. There was no significant difference in the serum level of chloramphenicol between susceptible and resistant groups to the drug. Results were interpreted and discussed.     

Diagnostic value of bone marrow culture in typhoid fever

The diagnostic efficacy of bone-marrow culture, serial blood cultures and agglutination tests was compared in a prospective study of 60 patients with typhoid fever, two thirds of whom had received prior antibacterial therapy. Salmonella typhi was recovered from marrow cultures in 95% of patients but blood cultures were positive in only 43.3% (P less than 0.001). Agglutination tests were eventually diagnostic in 56.7% of patients, but in only 25% at the time of admission. If procedures had been limited to blood cultures and agglutination tests, diagnosis would have been missed in 21.7% of cases. The efficacy of marrow cultures was affected not by the duration of disease but by the extent of antibacterial therapy before presentation. Bacteriological recovery was faster from marrow cultures.     

4018份血培养中厌氧血培养的价值分析

目的 了解送检厌氧血培养瓶对病原菌检出率及阳性结果报告时间的影响.方法 对2011年1月-2012年3月送检的4018份疑似血流感染患者的血培养结果进行统计学分析.结果 同时送检需氧瓶和厌氧瓶的检出率达14.11％,高于仅送检需氧瓶的9.26％,差异有统计学意义(P＜0.05);厌氧瓶中大肠埃希菌和肠球菌属的阳性结果报告时间(306、630min)明显短于需氧瓶(612、810 min)(P＜0.05);同时送检需氧瓶和厌氧瓶的病份中,厌氧瓶阳性而需氧瓶阴性者占2.42％,厌氧瓶培养可增加血流感染病原菌检出率达17.11％.结论 增加厌氧瓶培养可以提高阳性率并缩短阳性结果报告时间,临床上要加强厌氧血培养瓶的送检.     

322份血培养阳性病原菌在需氧、厌氧瓶的检出率比较

目的 分析2010年7月-2011年7月血培养阳性的病原菌在需氧、厌氧瓶检出率.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2700份血培养中阳性322份,阳性率为11.9％,其中革兰阳性球菌占24.5％、革兰阳性杆菌占0.6％、革兰阴性球菌占0.3％、革兰阴性杆菌占65.8％、厌氧菌占2.0％、真菌占6.8％;其中仅需氧血培养阳性130份,占40.4％,仅厌氧血培养阳性60份,占18.6％,需氧与厌氧血培养均阳性132份,占41.0％.结论 同一患者同时进行需氧瓶及厌氧瓶培养,即能充分体现自动血培养仪快速性,又能提高血培养阳性率.     

Skin antiseptics in venous puncture-site disinfection for prevention of blood culture contamination: systematic review with meta-analysis

Blood cultures drawn by venous puncture are common clinical procedures for the detection of bacteraemia. Blood culture contamination (BCC) can lead to clinical misinterpretation and unnecessary expenses. We aimed to systematically review randomised controlled trials (RCTs) with skin antiseptics for prevention of contamination in venous-puncture drawn blood cultures. We conducted database search using CENTRAL (Cochrane Library issue April 2010), MEDLINE, EMBASE and mRCT, in June 2010. All RCTs testing skin antiseptics in venous-puncture drawn blood cultures were retrieved. Relative risk (RR) of the BCC outcome was analysed by random effects method using confidence interval (CI) of 95%. Studies were assessed by one review author and checked by another. Six studies were identified. Single-trial comparisons showed that alcoholic iodine tincture was better than non-alcoholic povidone-iodine, and isopropyl/acetone/povidone-iodine showed superiority against isopropyl/povidone-iodine. Meta-analysis demonstrated that alcoholic chlorhexidine was better than non-alcoholic povidone-iodine (RR: 0.33; 95% CI: 0.24-0.46) in 4757 blood cultures from two trials. Alcoholic solutions were better than non-alcoholic products (0.53; 0.31-0.90) in 21,300 blood cultures from four studies. Two trials with 13,418 blood cultures showed that iodine tincture was not superior to povidone-iodine in BCC prevention (0.79; 0.54-1.18). Alcoholic iodine was not different from non-alcoholic iodine (0.79; 0.53-1.17). Comparison of chlorhexidine vs iodine compounds was not conclusive. Alcohol alone was not inferior to iodinated products for prevention of contamination in venous-puncture drawn blood cultures. The association of alcohol and povidone-iodine did not seem to be useful. Alcoholic chlorhexidine solutions reduced blood culture false positives compared with aqueous povidone-iodine.     

A comparative study of blood culture sampling from umbilical catheter line versus peripheral site

Neonatal sepsis is an important cause of death and morbidity in newborns and is diagnosed by isolation of organism in blood culture. In several reports,reliability of blood cultures were done from umbilical catheters,have been demonstrated. The objective of the present study was to determine, wether an indewelling umbilical catheter, could be an alternative site for blood culture. In a prospective study over 6 months during 2006, 141 paired blood cultures from 134 infant,were done simultaneously from peripheral site and umbilical catheter (mostly U. V. C),during the first four days of life. Majority of these infants were preterm and admitted to NICU for special care. these infants had indwelling umbilical line and had indication of sepsis workup. A total of 141 pairs of blood cultures were obtained from 134 infants. In 16 infants blood culture pairs were positive for one organism in both peripheral vein and umbilical site. 71. 6% of total cultures (n=11) pairs were negative in both sites. A total of 22 pairs were positive in one site only,with 5 positive from peripheral vein only and the other 17 from umbilical site. Two pairs were positive in both sites with two different organism. In over all 16 infant (11%) of blood were considered to be contaminated. Contamination rate were 2. 4% and 9. 2% for peripheral and umbilical catheter site. Contamination rate increased after 48 hours of age in umbilical catheter. The result showed that after 2 days contamination rate for blood culture taken from catheter line increased and specificity decreased. We recommended that blood culture via umbilical catheter in first 2 days in sick neonates with indwelling catheter can be a alternate site of blood culture sampling.     

Determining the significance of coagulase-negative staphylococci isolated from blood cultures at a community hospital: a role for species and strain identification.

OBJECTIVES: To determine the degree to which species identification or strain relatedness assessment of successive blood culture isolates of coagulase-negative staphylococci (CNS) may improve the clinical diagnosis of bloodstream infection (BSI). SETTING: 400-bed community hospital. DESIGN: Prospective laboratory survey during which all CNS blood culture isolates obtained between mid-August 1996 and mid-February 1997 (study period) were saved and later identified to the species level; selected isolates were genotyped using pulsed-field gel electrophoresis at the Centers for Disease Control and Prevention (CDC). Retrospective review of medical records of 37 patients with multiple cultures positive for CNS. RESULTS: During the study period, 171 patients had blood cultures positive for CNS; 130 had single positive cultures and 41 had > or =2 positive cultures. Of these 41, 23 (62%) were from patients with signs and symptoms of BSI according to CDC surveillance definitions. Species identification and strain clonality of CNS isolates from patients with > or =2 positives revealed 3 (13%) of the 23 patients did not have a consistent CNS species, and another 3 (13%) did not have a consistent genotype in the > or =2 positive cultures, suggesting that CNS from these patients probably were contaminants. Thus, species identification and strain clonality assessment reduced by 27% the number of patients with BSI diagnosed based on the presence of symptoms and > or =2 positive blood cultures. CONCLUSIONS: Routine species identification and selected strain genotyping of CNS may reduce the misinterpretation of probable contaminants among patients with > or =2 positive blood cultures.     

新生儿血液细菌培养结果及耐药性

目的:了解本地区新生儿患者血液感染类型及耐药性情况,为临床合理用药提供依据。方法:回顾分析2006年1月-2009年12月,本院新生儿室送检的3390例血培养及体外抗生素药敏试验结果。血培养使用Bact/ALERT 3D(120)全自动血培养系统及其配套的培养瓶,病原菌鉴定及药敏试验采用法国Biomerieux公司的API细菌鉴定系统及配套试剂条。结果:在3390例新生儿血培养中,细菌培养阳性416例,阳性率为12.3%。革兰阳性菌有402株占96.6%,革兰阴性菌有14株占3.4%。检出最多的病原菌是凝固酶阴性葡萄球菌(CNS),其次是肠球菌、金黄色葡萄球菌、大肠埃希菌,未发现B组溶血性链球菌(GBS)。其中甲氧西林耐药的凝固酶阴性葡萄球菌(MRCNS)247株检出率为80.2%(247/308),甲氧西林耐药的金黄色葡萄球菌(MRSA)21株检出率为72.4%(21/29),两者无统计学差异(χ2=0.363,P=0.547)。MRCNS的耐药状况比MRSA严重,未发现对万古霉素耐药的葡萄球菌和肠球菌,大肠埃希菌、肺炎克雷伯菌对亚胺培南均敏感。结论:CNS为本地区新生儿败血症的主要病原菌,进一步加强对新生...     

Predicting clinical outcomes in patients with negative peripheral and positive central blood culture with coagulase negative Staphylococcus species

Objectives: Clinical outcomes in patients with negative peripheral and positive central blood culture with coagulase negative staphylococci (CoNS) based on different treatment approach such as intravenous antibiotics, removal of CVC, combined approach or just observation are not known.

Methods: We conducted a retrospective review of patients with negative peripheral and paired positive central blood culture with CoNS admitted at our affiliated hospital between 2008 to 2013. We compared clinical outcomes such as bacteremia, catheter related blood stream infection (CRBSI), mortality and Intensive care unit (ICU) admission over the next 90 days between the 4 groups based on the treatment approach: (1) No treatment received, 2) catheter removed, no antibiotics administered, 3) antibiotics administered, catheter not removed and 4) antibiotics administered, catheter removed). Logistic regression was used to assess the association between treatment approach and outcomes after adjusting for confounding variables.

Results: 181 patients were included in the study and followed for 90 days after their initial positive blood cultures. 25 patients (14%) had bacteremia, 4 patients (2%) had CRBSI, 40 patients (22%) died and 10 patients (6%) had an ICU admission in the next 90 days. None of the outcomes differed statistically between the 4 groups.

Conclusion: Our study is the first to report no difference in the clinical outcomes in patients with negative peripheral and positive central blood culture with CoNS when compared based on treatment approach. Our study provides initial evidence that treating patients with an isolated central blood culture with CoNS does not change short term clinical outcomes.     

The primary isolation by haemoculture of Trypanosoma (Schizotrypanum) cruzi from animals and from man.

The results of the primary isolation of Trypansoma cruzi by haemoculture using a standard method, were successful for all of 14 experimentally infected mice, all naturally infected Didelphis azarae (eight animals: nine isolations) and six acute patients, but only for seven of 16 chronic patients. Two further chronic patients yielded positive cultures when the supernatant of slowly centrifuged blood fractions were inoculated.The low proportion of successful isolations from the group of chronic patients (maximum 56%) is probably mainly due to the low parasitaemia in this group.Haemoculture from the chronic patients also differed markedly from those from the other hosts in the very slow growth-rate obtained. This could not be explained solely by the small number of parasites inoculated. Serial ten-fold dilutions of infected mouse blood, down to 10^?5 ml of microscopically negative blood, did not prolong the in vitro pre-detection period of T. cruzi beyond two to four weeks, but the pre-detection in cultures from the chronic patients extended up to six months (range: six to 22 weeks, average 12 weeks).Factors that may be responsible for this phenomenon include unfavourable conditions in the culture media, the production of non-motile extra-cellular amastigotes (easily missed microscopically), the morphological characteristics of the original blood-stream trypomastigotes and humoral and cellular factors in the blood inoculated. Although some or all of these factors may contribute to the final outcome of haemoculture, consideration of the culture patterns observed suggests that the main factors responsible for the slow growth of T. cruzi in the cultures from chronic patients were the continuing activities of the humoral and cellular components in the blood inoculum.     

Molecular epidemiology of catheter-related bloodstream infections caused by coagulase-negative staphylococci in haematological patients with neutropenia

Catheter-related bloodstream infection (CRBSI) caused by coagulase-negative staphylococci (CNS) is common in haematological patients with febrile neutropenia. As the clinical signs of CRBSI are usually scarce and it is difficult to differentiate from blood culture contamination, we tried to confirm CRBSI by molecular typing of CNS isolated from paired blood cultures (one from a peripheral vein and another from the central venous catheter hub). Blood cultures were positive in 59 (36%) out of 163 patients. CNS were isolated in 24 (40%) patients; in 14 from paired blood cultures (28 isolates) and in 10 from a single blood culture. CNS from paired blood cultures were identified as Staphylococcus epidermidis. Antimicrobial susceptibility was determined and bacteria were typed by pulsed-field gel electrophoresis (PFGE) of bacterial genomic DNA. In 13 patients, the antibiotic susceptibility of isolates was identical. The PFGE patterns from paired blood cultures were identical or closely related in 10 patients, thus confirming the presence of CRBSI. In the remaining four patients they were unrelated, and suggested a mixed infection or contamination. Since CNS isolates from three patients had identical PFGE patterns, they were probably nosocomially spread amongst them.     

Comparison of large-scale mammalian cell culture systems with egg culture for the production of influenza virus A vaccine strains

Different types of microcarriers were assessed for the large-scale culture of influenza virus in the Madin-Darby canine kidney (MDCK) cells. Both porous and solid carriers were examined. A higher titre of influenza A/PR8/34 virus was recovered from cultures using solid (1.3x10(9) PFU per ml) rather than porous carriers (4.0x10(8) PFU per ml). High titres of virus (1.0x10(9) PFU per ml) were also obtained from roller bottle cultures of MDCK cells and the traditional culture technique using embryonated hens' eggs (3.9x10(9) PFU per ml). We found that solid carriers composed of dextran with a positive charge are the most suitable carriers for the large-scale growth of influenza A virus in MDCK cells using serum-free media.     

Impact of mycobacterial culture among HIV-infected adults with presumed TB in Uganda: a prospective cohort study

Background: Implementation of new tuberculosis (TB) diagnostic strategies in resource-constrained settings is challenging. We measured the impact of solid and liquid mycobacterial cultures on treatment practices for patients undergoing TB evaluation in Kampala, Uganda.Methods: We enrolled consecutive smear-negative, human immunodeficiency virus positive adults with cough of ⩾2 weeks from September 2009 to April 2010. Laboratory technicians performed mycobacterial cultures on solid and liquid media. We compared empiric treatment decisions with solid and liquid culture in terms of diagnostic yield and time to results, and assessed impact on patient management.Results: Of 200 patients enrolled, 26 (13%) had culture-confirmed TB: 22 (85%) on solid culture alone, 2 (8%) on liquid culture alone, and 2 (8%) on both solid and liquid culture. Thirty-four patients received empiric anti-tuberculosis treatment, but only 10 (29%) were culture-positive. Median time to a positive result on solid culture was 92 days (interquartile range [IQR] 69–148) compared to 106 days (IQR 66–157) for liquid culture. No patients initiated treatment following a positive result on liquid culture.Conclusion: The introduction of mycobacterial culture did not influence care for patients undergoing evaluation for TB in Kampala, Uganda. Attention to contextual factors surrounding implementation is needed to ensure the effective introduction of new testing strategies in low-income countries.     

Use of a high-sensitivity rapid strep test without culture confirmation of negative results: 2 years' experience

BACKGROUND: Optimal diagnostic management of patients with pharyngitis is controversial. In our study, we compared streptococcal complication rates at a large suburban medical center during 2 time periods: when pharyngitis patients were managed almost exclusively with throat culture and when they were managed primarily with a high-sensitivity antigen test without culture confirmation of negative results. METHODS: Using a combination of Current Procedural Terminology and International Classification of Diseases, Ninth Revision codes, we studied all patients seen for either pharyngitis or known streptococcal complications during a 4-year period. We then reviewed all available charts of patients with known streptococcal complications for coding accuracy. We compared streptococcal complication rates during each -time period. RESULTS: A total of 30,036 patients were seen for pharyngitis during the 4 years. A streptococcal diagnostic test was used in 66% of patient encounters. During the first 2 years (period 1), 99.9% of the tests ordered were blood agar plate throat cultures. During the second 2 years (period 2), 76.6% of tests ordered were high-sensitivity antigen tests without culture confirmation of negative results. Suppurative complications occurred in 37 patients in period 1 and 36 patients in period 2. There were no cases of acute rheumatic fever in either period. There was one case of poststreptococcal glomerulonephritis in period 2. CONCLUSIONS: Use of a high-sensitivity antigen test without culture confirmation of all negative results has not been associated with an increase in suppurative and nonsuppurative complications of group A beta-hemolytic streptococci.     

两种培养液用于未成熟卵体外培养成熟治疗多囊卵巢综合征不孕症效果比较

目的:比较两种培养液用于卵母细胞体外成熟(IVM)技术治疗多囊卵巢综合征不孕症的效果。方法:取出未成熟卵母细胞置于Ⅰ、Ⅱ两种成熟培养液中进行体外培养成熟后行单精子胞浆注射,受精后取优质胚胎移植宫腔,同时比较其对助孕结局的影响。结果:两组共23例患者进行了24个IVM治疗周期。Ⅰ组的获卵率,成熟率,受精率,卵裂率,种植率和妊娠率分别为:47.42%,70.30%,95.52%,84.38%,3.13%,5.88%;Ⅱ组分别为47.47%,70.21%,84.85%,71.43%,30.77%,50.00%。Ⅱ组的妊娠率,种植率显著高于Ⅰ组(P<0.05),两组获卵率,成熟率,受精率,卵裂率差别无统计学意义(P>0.05)。结论:IVM对卵泡发育和成熟障碍的多囊卵巢综合征患者助孕有效,用含0.1 IU/ml的hCG,0.5μg/ml E2的卵子成熟培养液助孕效果较好。