血培养检出病原菌分布及双份血培养法的价值分析

摘要

Objective To investigate the distribution of pathogens detected in blood cultures and the value of double blood cul‐ture .Methods There were 2 033 cases of blood cultures including 1 425 cases of single blood culture and 608 cases of doube blood cultures were in the study .Blood cultures were performed by using Bact/Alert3D automated detection system ,and the positive blood culture results were statistically analyzed .Results There were 251 blood culture positive samples ,the detection rate was 12 .3% (251/2 033) .Among them ,the positive rate of single blood culture was 11 .9% (169/1 425);positive rate of double blood culture was 13 .5% (82/608) .There were 216 strains of pathogenic bacteria(repeatedly culture of the same pathogen from the same patient only accounted for 1 strain) .The isolates of gram positive(G+ ) cocci accounted for 65 .7% (142/216) and the major bacteria were coagulase negative Staphy lococci .Escherichia coli and Acinetobacter baumannii were the dominant isolates among Enterobac‐teriaceae[accounted for 20 .8% (45/216)] and Non‐fermenting gram‐negative(G-) rods[accounted for 8 .8% (19/216)] ,respective‐ly .The isolating rate of doube blood cultures was significantly higher than the single one(P<0 .05) .Coagulase‐negative staphylo‐coccus were isolated primarily in single blood culture and double blood culture with only one test postive .Non‐fermenting gram‐neg‐ative rods and fungi were the most common strains isolated from double blood culture with two tests both postive .Conclusion The distributions of pathogens isolated from single blood culture ,double blood culture with only one test positive and two tests positive are different .Because collecting double sets of blood cultures can significantly increase the isolating rates and distinguish contamina‐tion from real bloodstream infection ,collecting double sets of blood cultures should be recommended .Double blood culture is helpful to improve the detection rate of pathogenic bacteria and bacteria identification .%目的：分析该院血培养检出病原菌的分布和探讨双份血培养法在血流感染诊断中的价值。方法采集疑似血流感染患者的血液标本共2033份，1425份标本采用单份血培养法，608份标本采用双份血培养法进行检测。标本置Bact／Alert3D全自动血液培养仪进行血培养，对血培养阳性标本进行统计学分析。结果血培养阳性的标本共251份，检出率为12．3％（251／2033）。其中，单份血培养法检出率为11．9％（169／1425）；双份血培养法检出率为13．5％（82／608）。血培养共检出216株病原菌（同一患者多次培养出同一病原菌计为1株）。其中，革兰阳性（G＋）球菌占65．7％（142／216），以凝固酶阴性葡萄球菌为主；肠杆菌科细菌占20．8％（45／216），以大肠埃希菌为主；革兰阴性（G －）非发酵菌占8．8％（19／216），以鲍曼不动杆菌为主；真菌占3．2％（7／216）。双份血培养法的病原菌检出率高于单份血培养法的检出率（ P＜0．05），单份血培养阳性和双份血单瓶阳性检出病原菌以凝固酶阴性葡萄球菌所占比例最大（＞40．0％），双份血培养双瓶阳性检出的病原菌以G－非发酵菌及真菌常见。结论双份血培养双瓶阳性与单份血培养阳性、双份血培养单瓶阳性检出的主要病原菌类型不同。双份血培养对提高病原菌检出率和污染菌鉴别有一定作用。