新型树脂BacT/Alert血液培养瓶抗菌药物吸附能力评估

目的 评估新型树脂BacT/Alert聚合物吸附珠血培养瓶(Bact/Alert APB需氧瓶,简称需氧瓶Bio-FA plus; Bact/Alert APB厌氧瓶,简称厌氧瓶Bio-FN plus)的抗菌药物吸附能力。方法 采用体外模拟实验比较新型树脂BacT/Alert聚合物吸附珠血培养瓶(需氧瓶Bio-FA plus;厌氧瓶Bio-FN plus)和不含抗菌药物中和物质的BacT/Alert标准需氧瓶(简称需氧瓶Bio-SA)的阳性检出率和检出时间。抽取标准需氧瓶Bio-SA、新型树脂需氧瓶Bio-FA plus和厌氧瓶Bio-FN plus随机分为对照组和实验组,实验组血培养瓶接种磷酸缓冲盐溶液(PBS)和一定浓度的标准菌株菌悬液;对照组接种PBS、一定浓度的标准菌株菌悬液和一定浓度的临床常用抗菌药物溶液(头孢哌酮/舒巴坦、万古霉素、头孢唑啉、哌拉西林/他唑巴坦、米卡芬净、亚胺培南),记录并比较各组血培养瓶5 d内的阳性检出率及检出时间。结果 实验组新型树脂需氧瓶Bio-FA plus的检出率为83.33%,厌氧瓶Bio-FN plus的检出率为100.00%,与标准需氧瓶B...     

BaCT/Alert全自动血培养系统在儿科中的应用研究

目的评价BacT/A1ert连续监测血培养系统检出儿科常见血培养分离菌的孵育时间.方法分析BacT/Alert全自动血培养系统检出1 426份新生儿和小儿阳性血培养瓶败血症病原菌的检出时间特点.结果1 426份新生儿和小儿血培养标本被系统检出阳性培养瓶133份,分离阳性率9.33%,其中革兰阳性菌占75.8%、革兰阴性菌占21.9%、真菌占2.3%;133份阳性培养瓶被系统于12,24,36,48,72 h及96 h的检出率分别为10.4%,67.5%,85.4%,93.7%,96.7%和99.7%.结论BacT/AlerT全自动血培养系统可在48 h以内检出93.7%的儿科败血症重要病原菌,实验室可在系统监测2 d后发出血培养的一级报告,48 h系统监测结果为阴性的培养瓶可能培养出真菌、四联球菌、溶血巴斯德菌及某些认为是污染的革兰阳性杆菌,可将系统监测时间确定为5 d.     

自动化血培养仪在血流感染中的应用价值

目的探讨如何提高血培养阳性率,快速、准确地作出病原学诊断。方法用Bact/AlLERT3D全自动血培养仪对9892例血培养进行检测,针对不同年龄患者对象选标准需氧瓶、厌氧瓶和儿童专用培养瓶进行增菌培养。结果 3d血培养阳性的灵敏度为99.4,特异度为99.8,血培养阳性率为12.29(1216/9892),阳性预测值为99.8,阴性预测值为99.8,污染率为0.28,共检出33种菌,沙门菌占第1位,为74.34(904/1216);凝固酶阴性葡萄球菌占第2位,为12.9(157/1216);其次是大肠埃希菌,占3.54(43/1216)。结论 Bact/ALERT血培养阳性实行三级报告制度可大幅度缩短时间,为临床及时修正用药提供依据,结合革兰染色和临床表现,Bact/ALERT血培养阳性标本直接行Vitek-32细菌鉴定和药敏具有较高应用价值。     

636例血标本的病原菌种类分布与耐药性研究

目的 了解本院血培养分离到的病原菌菌种及对抗生素的耐药性.方法 利用Bact/Alert3D全自动血培养仪及其配套的血培养瓶对636份标本进行血培养,阳性血培养转种后用MicroScan A/s-4细菌鉴定及药敏测试仪进行测试.结果 636份血培养标本中,检出病原菌65株(10.22%),革兰阳性球菌占40%,革兰阴性杆菌占55.4%,真菌占4.6%,葡萄球菌属和肠杆菌科的细菌是本院菌血症和(或)败血症的主要病原菌.革兰阳性球菌中未发现对万古霉素耐药的菌株,革兰阴性杆菌对亚胺培南有高度敏感性,但对常用抗生素有较普遍的耐药性.结论 血培养检出菌种复杂,耐药率高,应加强血培养中致病菌及其对抗生素的耐药性监测.     

某院2010～2011年血培养分析

目的了解单侧单瓶血培养的阳性率与检出菌的分布状况。方法对该院2010年1月至2011年12月所有送检的血培养标本进行分析,采用BacT/ALERT 3D120全自动血培养仪培养,阳性瓶按《全国临床检验操作规程》进行转种,用ATB Expression系统进行菌株鉴定。结果 2010年送检914份,阳性54份,阳性率5.9%。2011年送检2 335份,阳性142份,阳性率6.1%。结论单侧单瓶血培养阳性率低,应常规开展双侧双套或双瓶血培养。     

三种自动化微生物培养系统检测性能比较及评价

目的比较3种自动化微生物培养系统(Versa TERK、BACTEC FX、Bact/Alert 3D)的细菌检测性能,探讨快速及准确的病原学检测方法。方法使用3种不同检测原理的自动化微生物培养系统对11株标准菌株进行培养检测,比较不同浓度的菌液在需氧和厌氧瓶中的检出时间,对3种自动化微生物培养系统检测效果进行评价。结果 3种自动化微生物培养系统5 d内均检测出11株标准菌株,在需氧瓶中所有细菌平均检出时间最短的依次是Versa TERK (13.44 h)、BACTEC FX (22.13 h)、Bact/Alert 3D (26.61 h);而在厌氧瓶中,所有细菌的平均检出时间最短的依次是BACTEC FX(15.86 h)、Bact/Alert 3D (17.52 h)、Versa TERK (17.65 h)。在所有细菌中,大肠埃希氏菌最早被检出,该菌在Versa TERK需氧瓶中被检出时间最短(7.43±0.75 h);白色假丝酵母菌被检出时间最晚,该菌在Versa TERK需氧瓶中被检出时间最短(20.26±1.25 h)。同时3种自动化微生物培养系统均能检出30 CFU/mL、50 CFU/mL、100 CFU/mL、200 CFU/mL 4个浓度的细菌,且细菌的浓度会影响微生物培养系统的检出时间,浓度越高,细菌检出时间越短。结论 3种自动化微生物培养系统均可满足采供机构全血及血液成分细菌检测的需求,其中Versa TERK的细菌检出时间略早于另外2种系统;另外细菌浓度的改变会影响3种自动化血微生物培养系统的检出时间。     

双侧双瓶血培养在临床应用的初步研究

目的探讨双侧双瓶血培养在临床应用的必要性。方法采用全自动血培养仪对2010年4月～2011年4月南京医科大学第一附属医院血液科送检的693份血液标本进行培养,对双侧双瓶、单侧双瓶和单侧单瓶血培养的真阳性率和污染率分别进行统计学分析。结果 308份双侧双瓶标本中,有44份培养出细菌,其中37份为有意义阳性标本,真阳性率为12.0%(37/308),污染率为2.3%(7/308);320份单侧双瓶标本中,阳性标本31份,有意义的阳性标本23份,真阳性率为7.2%(23/320),污染率为2.5%(8/320);65份单侧单瓶标本中,有7份细菌生长,其中4份为凝固酶阴性葡萄球菌生长,真阳性率为4.6%(3/65),污染率为6.2%(4/65)。双侧双瓶血培养真阳性率明显高于单侧双瓶(χ2=4.051,P<0.05)及单侧单瓶,但与后者比较无统计学意义。3种培养方法污染率比较差异无统计学意义(P>0.05)。结论双侧双瓶血培养可提高血培养阳性率,且并不增加污染率。推广双侧双瓶血培养在临床应用有一定价值。     

血培养阳性病原菌报警时间的临床意义

目的分析血培养阳性病原菌阳性报警时间(TTP)的临床意义。方法对2013年3月至2015年2月Bact/Alert240检测出的血培养阳性标本致病菌种类和阳性报警时间进行回顾性研究分析。结果 5 408例血培养标本中Bact/Alert240报警692例,分离细菌683例,阳性率为12.6%;肠杆菌、葡萄球菌属、非发酵菌属、链球菌属、肠球菌属和真菌有着各自不同的阳性报警时间段。0~12h时间段内肠杆菌科大肠埃希菌为最主要的致病菌,占84.8%;12~24h时间段内葡萄球菌属为最主要的致病菌,占44.3%。结论通过Bact/Alert240的报警时间、革兰染色及镜下形态的观察,可初步判断病原菌的种类,第一时间指导临床医生准确而合理地选择抗菌药物。     

不同送检模式下血培养阳性率与病原菌的分布

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：5.565份血培养标本,培养出687株病原菌,阳性率为12.3%（687/5 565）;其中双侧双瓶血培养送检率为87.6%（4 875/5 565）,阳性率为12.8%（624/4 875）,明显高于单侧单瓶的阳性率9.0%（30/335）（χ^2=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%（6133）。在双侧双瓶标本分离的624株病原菌中,有了7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。     

BacT/Alert 3D系统2种细菌培养瓶的临床应用对比评价

目的评价Bact／Alert 3D全自动血培养仪配套标准需氧（SA）瓶和中和抗生素需氧（FA）瓶临床应用情况。方法采用Bact／Alert 3D全自动血培养系统配套标准需氧瓶和中和抗生素需氧瓶平行监测。在SA和FA培养瓶中同时加入一定量抗生素和菌液比较2种培养瓶对抗生素的吸附能力;标本培养周期为5d,不论系统显示阳性或阴性,均进行涂片检查和转种血琼脂、巧克力琼脂平板培养,观察2种瓶检出细菌时间、阳性率、敏感性、特异性、准确性、假阳性率,假阴性率等。结果96例平行接种标准需氧瓶和中和抗生素需氧瓶标本中,2种瓶最快阳性检出时间均为1．5h;SA培养瓶检出20例阳性,阳性率为20．8％,敏感性为95．0％,特异性为98．7％,准确度为97．9％,假阳性率为5．0％,假阴性率为1．3％;接种FA培养瓶检出26例阳性,阳性率为27．1％。敏感性为96．0％,特异性为97．2％,准确度为96．9％,假阳性率为7．7％,假阴性率为1．4％。标准菌株在含4倍最低抑菌浓度抗生素的FA瓶中仍能生长,但在含同样抗生素的标准瓶中不生长。结论在Bact／Alert 3D仪各项技术指标及实验室环境符合要求的条件下,标准需氧瓶和中和抗生素需氧瓶均为较好的配套培养瓶;接受抗生素治疗的患者,使用中和抗生素需氧（FA）瓶比标准需氧（SA）瓶阳性检出率更高。     

3种不同全自动血培养仪的临床应用及评价

目的评估Bact/Alert 3D、BD BACTEC FX以及Versa TREK 3种不同全自动血培养仪之间的应用价值及其相互差异。方法比较3种仪器的培养结果的报阳时间及延迟培养的报阳时间,评价3种仪器的临床应用价值。结果 3种血培养仪在培养时间的比较上,BD的最短报阳时间的瓶数所占比例是29.4%,梅里埃的最短报阳时间的瓶数所占比例为11.8%,Versa TREK的最短时间报阳瓶数所占比例为58.8%。在延迟培养的比较中,3种仪器的时间差距较小,延迟培养条件下建议在常温下保存(4℃条件下苛养菌可能死亡)。结论Versa TREK在细菌的培养时间上有一定的优势,但其存在操作较为繁琐,污染率相对较高的风险,Bact/Alert 3D、BD BACTEC FX在培养时间上差距不是很大,且操作方便。     

The performance of 4 different supplements and 5 blood culture bottles types in detection of bacteria and Candida spp. in simulated sterile body fluid cultures

The purpose of this investigation was to evaluate the performance of 4 supplements: horse blood, fastidious organisms supplement (FOS), haemin isovitalex albumine (HIA), and brain heart infusion–haemin isovitalex albumine (BHI-HIA) and 5 blood culture bottles: Bactec Mycosis IC/F, Plus Aerobic/F, Peds Plus/F from the Bactec 9240 system, and BacT/Alert FA and BacT/Alert PF from the BacT/Alert 3D system, in detection of bacteria and Candida spp. in simulated sterile body fluids other than blood models. In total, 8 reference strains (Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Listeria monocytogenes, Candida albicans, and Candida parapsilosis) and 11 clinical bacteria and yeast isolates (6 isolates from cerebrospinal fluid and 5 isolates from blood) were included in this study. Horse blood, FOS, and HIA were significantly better than no supplements (P < 0.0001, P < 0.0002, and P = 0.05, respectively) in detection of bacteria. Interestingly, there was no significant difference between BHI-HIA and bottles without any supplements. Sixty bottles analyzed of which 59 (98.33%) bottles with horse blood, 53 (88.33%) with FOS, 45 (75.00%) with HIA, and 43 (71.67%) with BHI-HIA signaled positive. The positivity rates with horse blood were significantly higher than with HIA and BHI-HIA (P < 0.0005 and P < 0.0001, respectively). Similarly, the blood culture bottles with horse blood had shorter time to detection (TTD) compared to bottles with FOS and HIA (P < 0.05 and P < 0.0001, respectively). When yeasts were analyzed, almost all (124/125) blood culture bottles with Candida spp. signaled positive even in the absence of supplements. Bactec Mycosis IC/F had significantly shorter TTD compared to Bactec Peds Plus/F, Bactec Plus Aerobic/F, BacT/Alert FA, and BacT/Alert PF bottles in detection of Candida spp. (P < 0.005, P < 0.05, P < 0.001, and P < 0.001, respectively). The present study showed that horse blood was the most effective supplement in growth of bacteria in the blood culture bottles that were analyzed in the study.     

两种需氧血培养系统对模拟菌血症检测能力的比较

目的比较BACTEC PLUS树脂需氧瓶与BacT／Alert FA活性炭需氧瓶对模拟菌血症的检测能力。方法选择烧伤科常用的抗生素与细菌病原体，将菌液、抗生素、新鲜无菌血注入各培养瓶内，记录5d内阳性瓶的检出时间及二者对万古霉素的吸附能力，对2种具有不同吸附剂的血培养瓶的阳性检出率及平均检出时间进行比较。结果除替考拉宁组外，BACTEC PLUS树脂需氧瓶的细菌阳性检出率和平均检出时间均优于BacT／Alert FA活性炭需氧瓶，差异有统计学意义（P〈0．001）；替考拉宁组BacT／Alert FA活性炭需氧瓶的细菌阳性检出率和平均检出时间优于BACTEC PLUS树脂需氧瓶。结论在进行血培养时，应该尽可能在抗生素使用以前或F次使用抗生素以前采血。对已经应用抗生素的患者，应选择具有中和、吸附抗生素能力的培养系统。     

国产全自动血培养系统及配套血培养瓶性能评估

目的 通过与美国BD BACTEC FX200全自动血培养系统的比较,对国产LABSTAR全自动血培养系统进行性能评估。方法 两种血培养系统分别使用标准菌株模拟样本和临床样本,分别对需养瓶和厌氧瓶进行评估。将标准菌株和疑似血流感染的临床样本按要求分别注入两种产品配套血培养瓶内进行培养,对比评估国产LABSTAR与对照产品结果的一致率,及阳性结果报警的时间差异。结果模拟样本评估结果:需氧瓶组评估23例模拟样本,两个血培养系统全部报阳,阳性报警时间无统计学差异。厌氧瓶组评估14例模拟样本,同时报阳的11例报警有统计学差异。临床样本评估结果:需氧瓶组531例,25例报阳结果相同,报警时间有统计学差异,培养结果总体一致率为96.4%; 厌氧瓶组361例,8例报阳结果相同,报警时间有统计学差异,培养结果总体一致率为95.8%。结论 国产LABSTAR全自动血培养系统与对照美国BD BACTEC FX200全自动血培养系统培养结果一致率高,但阳性结果报警时间偏长。     

Detection of bacteria and fungi in BacT/Alert standard blood-culture bottles

Incubation periods of aerobic (AE) and anaerobic (AN) blood-culture bottles with the BacT/Alert system were assessed in our laboratory. We reviewed the results of 6229 blood-culture sets collected at Kyoto University Hospital from January 1999 to December 2000. Of these sets, 731 (11.7%) were positive for bacteria or yeast. Excluding 87 sets with growth evidence on arrival, of the 644 positive blood-culture sets from 341 patients, a total of 691 organisms were isolated. Of the 691 organisms, 413 (59.8%) were recovered from both bottles, 206 (29.8%) were recovered only from the AE bottle, and 72 (10.4%) were recovered only from the AN bottle. The AE bottle was significantly superior to the AN bottle in terms of both recovery rate and detection time for overall organisms, but there was no significant difference in detection time for facultative anaerobic bacteria between the two bottles. Of the 691 organisms, 530 (76.7%) were classified as usual pathogens. Of the 530 usual pathogens, 501 (94.5%) were recovered in at least one bottle of each set within the first 3 days, and 523 (98.7%) within the first 5 days of incubation. Twenty-nine organisms initially isolated on day 4 or later were recovered from 19 patients. Of these, chart reviews indicated that 21 organisms recovered from 11 patients were considered clinically significant bacteria, and the reviews also revealed that no patient had a treatment plan altered based on the results of positive blood culture. Seven organisms initially isolated on day 6 or later were recovered from 7 patients. Chart reviews revealed that 5 of these organisms from 5 patients were considered to be clinically significant. In conclusion, if the incubation period had been less than 3 days, 11 patients with clinically significant bacteremia or fungemia, (3.2% of all patients with bacteremia or fungemia) would have been undiagnosed. Similarly, with an incubation period of 5 days, 5 such patients (1.5%) would have been undiagnosed.     

Evaluation of BACTEC Plus aerobic and anaerobic blood culture bottles and BacT/Alert FAN aerobic and anaerobic blood culture bottles for the detection of bacteremia in ICU patients

Blood culture is the most valuable laboratory test for the diagnosis of bacteremia and sepsis. The BACTEC FX and BacT/Alert 3D automated blood culture systems are commonly used in Korean health care facilities. A controlled clinical evaluation of the resin-containing BACTEC Plus aerobic (BA) and anaerobic (BN), and the charcoal-containing FAN aerobic (FA) and anaerobic (FN) bottles using blood from intensive care unit (ICU) patients was designed. The performances of these 2 systems with media containing particle absorbing antimicrobial agents were evaluated using the culture positivity rate and time to detection (TTD). TTD was collected using data management systems, either the Epicenter (BD Diagnostic Systems) or the hospital laboratory information system. A total of 1539 four-bottle sets were collected from 270 patients in medical and surgical ICUs. Blood culture samples included 1539 bottles each of BA, BN, FA, and FN, and yielded 113 (7.3%), 90 (5.8%), 104 (6.8%), and 80 (5.2%) positive bacterial or fungal isolates, respectively. There were significant differences between the resin-containing BA and BN samples in culture positivity and also between the charcoal-containing FA and FN samples, especially for Escherichia coli (25/27 versus 17/27, P < 0.05) and Acinetobacter baumannii (14/15 versus 7/15, P < 0.05). Significantly shorter recovery time was observed in BACTEC Plus aerobic bottles than in FAN aerobic bottles (17.2 and 24.7 h, respectively) (P < 0.001).     

Reassessment of the routine anaerobic culture and incubation time in the BacT/Alert FAN blood culture bottles

A total of 9,130 blood cultures were collected from adult patients with suspected bloodstream infections. The recommended 20 mL sample of blood was divided equally between the aerobic and anaerobic FAN bottles and monitored in the BacT/Alert Microbial Detection System for a total of 5 days. There were 757 clinically significant positive culture pairs from 291 patients. Significant differences were found with greater recovery of Pseudomonas aeruginosa (p < 0.001), Acinetobacter spp. (p = 0.002), coagulase-negative staphylococci other than Staphylococcus epidermidis (p = 0.002), and Candida spp. (p < 0.001) from the aerobic bottle and greater recovery of anaerobic bacteria (p < 0.001) from the anaerobic bottle. Significantly more episodes of P. aeruginosa bacteremia (p < 0.003) and candidemia (p < 0.001) were detected by the aerobic FAN bottle and significantly more episodes of anaerobic bacteremia (p < 0.001) were detected by the anaerobic FAN bottle (Table 2). No other significant differences between systems in their detection of bacteremias were noted. Anaerobic bacteremias were encountered in diverse and often unpredictable clinical settings. All clinically significant episodes of bloodstream infection were detected within 4 days of incubation of their cultures. We conclude routine, rather than selective, use of the anaerobic FAN bottle in the blood culture set and a 4-day incubation of blood cultures in the BacT/Alert aerobic and anaerobic FAN bottles is an appropriate routine procedure.     

1871份血培养病原菌的分布及耐药性分析

目的了解我院血培养分离病原菌的分布及耐药性。方法患者血培养标本经BacT/Alerti120血培养仪培养,分离所得菌株用法国生物梅里埃API系统进行鉴定和K-B法做药敏。结果1871份血培养标本中分离病原菌株216株,阳性率为11.9%。其中革兰阳性细菌占53.7%(116/216),对万古霉素100.0%敏感;革兰阴性杆菌占41.7%(82/216),对碳青酶烯类药物IPM敏感率较高,耐药率在10.0%以下;念珠菌占4.6%(10/216)。结论血培养分离的病原菌以革兰阳性球菌为主,病原菌的种类较多,耐药率高,临床医师应加强疑似血流感染患者血流中病原菌的检测,合理应用抗生素,提高治愈率。     

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