血培养的临床意义-培训课件.ppt

* * * 导管相关性血流感染（CRBSI）的血液培养 CRBSI是血流感染最常见原因，死亡率高达12%～35%。由于局部无感染迹象，而且常常是皮肤正常菌及假菌血症常见的细菌，所以临床很难确诊。 CRBSI的相关导管 估计有10～40万例导管相关性血流感染 最高发病率：ICU病区（2.5~30/1000中心导管天） CRBSI导致： 住院天数增加:7 ～ 24天 死亡率增加：增加3～4倍 增加治疗费用：大约$40000/生还者 流行病学 导管相关性血流感染（CR-BSI）的诊断 临床特征：脓、蜂窝组织炎、导管口周围的压痛 导管远端的半定量培养（Maki’s法）和其改良法（超声波降解法/冲管法） 血培养 定量 vs 常规 外周 vs 管道 CRBSI的诊断方法-1 不拔导管情况下判断： CRBSI的诊断方法-2 拔管情况下判断 内容 败血症简介 标本采集 血培养的临床意义 导管相关血流感染 小结 小结：临床问题 检测菌血症对临床十分重要 血培养分离的菌株有助于患者的诊断和治疗 正确的抗感染治疗会降低死亡率 小结：实验室问题 需使用含树脂的培养瓶才能达到最佳的检出率 至少应采集2份血培养 每次应抽取足量的血液 绝大多数的细菌在5天内可被检出 遵从CLSI的指南，有助于实验室达成“血培养的最佳实践” * * * The detection of pathogenic bacteria or fungi in a patient’s bloodstream has great diagnostic and prognostic significance. It is one of the most important tests performed in the Microbiology Laboratory. * Bacteremia and fungemia are major life-threatening infections that require appropriate antimicrobial therapy, administered in a timely fashion. Positive cultures should always be considered a medical emergency, and should be acted on promptly by the laboratory staff. The laboratory's role is to recover and identify the etiologic agent as rapidly as possible and to determine its susceptibility to antimicrobial agents. * * * * * * * 12 * Sepsis can be caused by a variety of microorganisms. As soon as sepsis is suspected, cultures for blood, as well as cultures to determine the source or the primary infection, should be taken. Empiric therapy is usually begun before culture results are known in an attempt to eradicate the infection. * It is generally accepted that empirical therapy must begin before culture results are known. Use of broad-spectrum antimicrobial agents are used to cover the most likely possibilities to eradicate the causative organism. Once culture results are known, the therapy can then be modified to a more appropriate, perhaps less costly drug regimen. * The initial choice by the physician on which antimicrobial agents to select should be based