上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2017, Vol. 37 ›› Issue (7): 978-.doi: 10.3969/j.issn.1674-8115.2017.07.017?

• 论著（临床研究） • 上一篇    下一篇

血培养阳性标本处理流程再造的初步探索

陈峰 *，李媛睿 *，刘瑛，俞静，皇甫昱婵   

  1. 上海交通大学 医学院附属新华医院临床检验科，上海 200092
  • 出版日期:2017-07-28 发布日期:2017-08-25
  • 通讯作者: ?刘瑛，电子信箱：lywjw0129@163.com
  • 作者简介:?陈峰（1981—），男，主管技师，硕士生；电子信箱：rocky810331.student@sina.com。李媛睿（1990—），女，技师，硕士；电子信箱：liyuanrui729@126.com。 *共同第一作者。
  • 基金资助:
    上海申康医院发展中心临床辅助科室能力建设项目（SHDC22014003）

Preliminary exploration of redesigning positive blood culture specimen processing flow#br#

CHEN Feng*, LI Yuan-rui*, LIU Ying, YU Jing, HUAGNFU Yu-chan   

  1. Department of Clinical Laboratory, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
  • Online:2017-07-28 Published:2017-08-25
  • Supported by:
    Clinical Auxiliary Departments Capacity Building Project of Shanghai Shenkang Hospital Development Center , SHDC22014003

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摘要： 目的 · 以分离胶促凝管联合 Microflex™基质辅助激光解析电离飞行时间质谱直接检测血培养阳性标本中细菌，并依据质谱鉴 定结果进行直接药敏试验，对传统血培养阳性标本处理流程再造进行初步探索。方法 · 收集 2015 年 9 月 1 日至 2016 年 8 月 31 日上 海交通大学医学院附属新华医院临床微生物实验室血培养报阳单菌株感染标本 449 份，按照新的血培养阳性标本处理流程进行操作。 改造后的新处理流程主要包括：涂片染色镜检、分离胶 / 质谱直接鉴定、菌膜 / 质谱鉴定、纯菌落 / 质谱鉴定、直接药敏试验和常规 药敏试验等。依据镜检、鉴定与药敏试验结果依次发出：Ⅰ级直接镜检报告、阳性血培养Ⅱ级（直接鉴定 / 菌膜鉴定或直接药敏）报 告和Ⅲ级最终报告。结果 · 改造后的新处理流程在工作当日 10： 00、17： 00 和次日10： 00 可分别获得 82.2%、95.8% 和 100% 阳性血 标本中细菌“种”水平鉴定结果并报告至临床；对于经初步评估有临床意义的病原菌在血培养阳性报警次日就能发出初步药敏结果报 告，且与常规药敏结果有较高的符合率。结论 · 与传统处理流程相比，改造后的处理流程使得血培养瓶阳性报警至发送初步鉴定和药 敏结果所需时间缩短 1 ～ 2 d，为临床医师提供快速准确的血流感染病原学诊断依据，对提高临床血流感染的早期诊断和治疗能力具 有重要意义。

关键词: 血流感染, 血培养阳性标本处理流程, 基质辅助激光解析电离飞行时间质谱, 直接药敏试验

Abstract:

Objective · To directly detect the bacteria in positive blood culture specimens by the separation gel tube combined with Microflex™ matrixassisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS), perform direct antimicrobial susceptibility test based on the results of mass spectrometry, and preliminary explore the redesign of conventional positive blood culture specimen processing flow.  Methods · 449 positive-alarm blood culture specimens of monobacterial infections in clinical microbiology laboratory of Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine from September 1, 2015 to August 31, 2016 were collected and prepared according to the new positive blood culture specimens processing flow. The new redesigned processing flow included smear staining and microscopy, separation gel/mass spectrometry direct identification, bacteria film/mass spectrometry identification, pure colony/mass spectrometry identification, direct antimicrobial susceptibility test, and conventional antimicrobial susceptibility test, etc. According to the results of microscopic examination, identification test, and antimicrobial susceptibility test, level Ⅰ direct microscopic examination report, positive blood culture level Ⅱ (direct identification/bacteria film identification or direct antimicrobial susceptibility) report, and level Ⅲ final report were provided sequentially.  Results · With the new redesigned processing flow, bacterial specieslevel identification reports for 82.2%, 95.8%, and 100% of positive blood samples could be obtain at 10 am and 17 pm on the current day and 10 am in the next morning, respectively, and be sent to clinical departments. Initial antimicrobial susceptibility reports for the bacteria that were considered as clinical significant pathogens by preliminary assessment could be provided in the next day of blood culture positive alarm with a higher coincidence rate as compared to the results of traditional antimicrobial susceptibility tests.  Conclusion · The time from blood culture positive alarm to the provision of initial identification and antimicrobial susceptibility reports is shorter by 1-2 d for the redesigned processing flow than for the traditional one, which can provide fast and accurate etiologic diagnosis evidence for bloodstream infections for clinicians and is important for improving early diagnosis and treatment of clinical bloodstream infections.

Key words: bloodstream infection, positive blood culture specimens processing flow, matrix-assisted laser desorption ionization time-of-flight mass spectrometry, direct antimicrobial susceptibility test