血培养的污染问题?

缭绕

今天在本论坛看到一篇文章，是关于血培养的污染问题，觉得非常好，可以判断血培养的结果是否可信！下载一看，却是英文的PDF格式，哪位高手翻译一下啊？:handshake

David

太长了吧，有点力不从心哦，不如大家分工如何，一人一亩责任田？:cool

txzhou

David,你可以多分点。

缭绕

我们期待着哦！

右手心

晚辈来抛砖引玉拉,希望各位高人有空闲时间的话一起来完成这篇文献吧.
毕竟偶水平有限,还请大家多多指教
:loveliness:
Although it has been widely appreciated for many years among physicians and microbiologists that blood cultures areamong the most important laboratory tests performed in the diagnosis of serious infections (35), it has become equally apparent in more recent years that contaminated blood cultures are common,enormouslycostly,andfrequently Confusing for clinicians(1,12,14,26).Clinicalstudiesofblood-stream infections over 3 decades have provided guidelines fordifferentiatingtruepathogensfromcontaminantsororganisms of unknown significance (14, 18, 41, 42); however, a true “gold standard” for differentiating pathogens from contaminants does not exist (4, 25). Moreover, the most common blood culture contaminants, coagulase-negative staphylococci (CoNS),which were almost always such several decades ago (18, 41),now are pathogens more frequently (19, 25, 26, 42), and judging the clinical significance of this group of microorganisms in bloodhasproventobeespeciallyproblematic(1,11,22,24,26, 42; S. J. Peacock, I. C. Bowler, and D. W. Crook., Letter,Lancet 346:191-192, 1995). This review focuses on how pathogen-contaminant decisions are made, the phenomenon of increasing contamination of blood cultures, potential methods for addressing high contamination rates, and practical labora-tory approaches to the workup of likely contaminants.

虽然在内科学和微生物学上已经多年普遍承认血培养是实验室诊断严重感染性疾病的最重要手段,但在近年,血培养污染事件,花费巨大以及误导临床现象也同样存在.超过30年的血液感染临床研究提供的从污染物或者有机体中区分病原体的指导也未见显著性.但是区分污染物病原菌的”金标准”确实不存在.另外,血培养污染最常见的病原菌,阴性凝固酶金葡菌,数十年前就存在,现在变的更加频繁.判断临床意义时候这组菌群显得特别可疑.这篇文献主要研究如何判定为病原菌污染,血培养污染的现状,有可能定位高污染率的方法,实际的指导实验室建立最易污染物.

txzhou

阴性凝固酶金葡菌,这可能是你的笔误吧，应该是凝固酶阴性葡萄球菌

右手心

嘿嘿,是的,不好意思啊,没有仔细检查:piouut

缭绕

右手心：
你很不错！因为你不是搞微生物的，难免啊，继续吧！

莲雾

右手心版主不是搞微生物的，能够如此翻译已经很不错了，我也翻译了这段前言，看看是不是更符合原文。希望大家齐心协力翻出全文，这篇文献虽然是2003年，但无论对临床还是对实验室判断血培养中的污染菌都有指导意义。

      血液培养作为诊断严重血流感染的最重要的实验室试验，尽管许多年来被临床医生和微生物学家广泛推崇，但近年来血培养污染经常发生，培养费用增加，误导临床，这些问题也是显而易见的。一些超过30年的血流感染临床研究为区分真正的致病菌和污染菌或非特异的微生物提供了指导方针。然而，真正能够判断致病菌和污染菌的“金标准”并不存在。此外，血培养中最常见的污染菌凝固酶阴性葡萄球菌（CoNS）几十年前几乎都被认为是污染菌，现在经常是致病菌，判断这一群微生物在血液中的临床意义尤其困难。本文着重介绍如何判断致病菌和污染菌，引起血培养污染增加的现象，解决高污染率的方法，实用的可疑污染菌实验室处理流程。

[ 本帖最后由 莲雾 于 2007-9-23 10:20 编辑 ]

桂花香

我翻译第三部分：
THE PARADOX OF INCREASING NUMBERS OF CONTAMINANTS似非而是的污染增加
Despite numerous advances in blood culture methodology and systems in recent decades, some hospitals and laboratories have noted that an increasing proportion of blood culture isolates represent contamination compared with those in years past (42). 尽管近几十年来血培养方法学和培养系统快速发展，一些医院和实验室却已经注意到污染的血培养菌株比例较过去上升。There are several possible explanations for this unexpected observation.出现这种非预期的结果有几种原因。The newer continuously monitoring blood culture systems have improved algorithms for detecting microbial growth and may be detecting microorganisms present in low numbers that previously were missed. 最近连续监测的血培养系统已经改进其监测方法来检测微生物的生长并有可能检测到过去无法检测的少量微生物。Moreover, several broth medium formulations such as the BACTEC Plus Resin media (Becton Dickinson, Sparks, Md.) and BacT/ ALERT FN media (bioMerieux, Durham, N.C.) have been shown to have improved detection of staphylococci, including CoNS which most often are contaminants (10, 20, 28, 38, 40, 43, 45). 而且，几种肉汤培养基成品如BACTEC加RESIN 培养基以及BACT/ALERT FN 培养基已经显示出其能够提高葡萄球菌，包括通常被认为是污染菌的凝固酶阴性葡萄球菌的检测。Thus, the ability of new systems and media to detect these organisms, even when present in small numbers, may be responsible in part for the observed increase in the proportion of blood cultures with contaminants. 因此，新系统和培养基可以检测到很少量微生物的能力可能与血培养污染比例上升有一定关系。The increased use of central venous access catheters and utilization of these devices for the purpose of obtaining blood specimens for culture may also be contributing to the increased numbers of contaminated blood cultures.中央静脉导管操作的增加以及通过这些装置抽取血培养标本也使血培养污染增加。 Several studies have documented increased contamination when blood cultures are obtained in this fashion (5, 6, 7; R. B. Sivadas, B. Vazirani, S. Mirrett, and M. P. Weinstein, Abstr. 101st Gen. Meet. Am. Soc. Microbiol., abstr. C10, 2001), perhaps because it is more difficult to sterilize these devices than it is the skin before blood is obtained. 几项研究已经发现通过这种方式采集的血培养污染机会增加，也许是因为采血前消毒这些装置比消毒皮肤更困难。Although physicians and nurses may believe they are saving patients the pain of an extra needle stick when blood cultures are obtained from catheters rather than by venipuncture, they may actually be doing their patients and the health care system a disservice if contaminants are grown from the culture resulting in the need for even more cultures, other diagnostic studies, unnecessary antibiotic therapy, and the associated incremental costs of care. 尽管医生和护士们可能认为他们从导管抽血而不另外穿刺静脉抽血是在减轻病人的痛苦，但实际上，他们可能正在损害病人和医疗卫生系统的利益，因为污染菌生长，将导致需要更多的培养、其他的诊断措施、不必要的抗生素治疗和相应的护理费用增加。Prior to the human immunodeficiency virus (HIV) era, blood cultures traditionally were obtained by a two-needle technique, using a sterile needle and syringe to perform the venipuncture, then changing to a second sterile needle before inoculating the blood culture vial.HIV时代前，传统的血培养是通过双针头技术获得，即用一个无菌针头和注射器来抽取静脉血，然后再换一个无菌针头把血液注入到血培养瓶。 The purpose of the twoneedle technique was to reduce the chance that skin microorganisms that might be present on the needle used for the venipuncture would be inoculated into the blood culture vial, thereby resulting in a contaminated blood culture. 采用双针头技术的目的是减少可能存在于静脉抽血针头上的皮肤微生物注入培养瓶，进而导致污染的血培养结果的机会。As the knowledge of HIV as a bloodborne pathogen and the risks of needle stick transmission of HIV became evident, several studies were undertaken to determine whether contamination rates would be affected if only one needle was used for both venipuncture and inoculation of blood culture vials (9, 15, 16). The results of each of these studies showed no significant increase in contamination rates when the single-needle technique was used. 随着HIV是经血传播病原体的认识和针刺传播HIV的危险被证实，旨在确定单针头用于静脉穿刺和注入血培养瓶是否会影响血培养污染率的几个研究已经进行，每一单项研究都没有发现单针头操作技术的血培养污染率显著增加。Subsequently, however, a meta-analysis suggested that single-needle blood cultures were associated with contamination rates of 3.7% compared with 2.0% when a two-needle technique was used (30). 然而，随后的Meta分析提示单针头操作的血培养污染率为3.7%，相比之下，双针头操作的血培养污染率是2.0%。Since the current standard of care continues to be the single-needle technique in order to reduce the risk of occupational needle stick injuries, slightly higher contamination rates may have to be tolerated. 既然现行的护理操作标准仍然是单针头操作以减少职业针刺伤的危险，我们可能不得不容忍血培养污染率的轻微增加。
似非而是的污染增加
尽管近几十年来血培养方法学和培养系统快速发展，一些医院和实验室却已经注意到污染的血培养菌株比例较过去上升。出现这种非预期的结果有几种原因。最近连续监测的血培养系统已经改进其监测方法来检测微生物的生长并有可能检测到过去无法检测的少量微生物。而且，几种肉汤培养基成品如BACTEC加RESIN 培养基以及BACT/ALERT FN 培养基已经显示出其能够提高葡萄球菌，包括通常被认为是污染菌的凝固酶阴性葡萄球菌的检测。因此，新系统和培养基可以检测到很少量微生物的能力可能与血培养污染比例上升有一定关系。中央静脉导管操作的增加以及通过这些装置抽取血培养标本也使血培养污染增加。几项研究已经发现通过这种方式采集的血培养污染机会增加，也许是因为采血前消毒这些装置比消毒皮肤更困难。尽管医生和护士们可能认为他们从导管抽血而不另外穿刺静脉抽血是在减轻病人的痛苦，但实际上，他们可能正在损害病人和医疗卫生系统的利益，因为污染菌生长，将导致需要更多的培养、其他的诊断措施、不必要的抗生素治疗和相应的护理费用增加。HIV时代前，传统的血培养是通过双针头技术获得，即用一个无菌针头和注射器来抽取静脉血，然后再换一个无菌针头把血液注入到血培养瓶。采用双针头技术的目的是减少可能存在于静脉抽血针头上的皮肤微生物注入培养瓶，进而导致污染的血培养结果的机会。随着HIV是经血传播病原体的认识和针刺传播HIV的危险被证实，旨在确定单针头用于静脉穿刺和注入血培养瓶是否会影响血培养污染率的几个研究已经进行，每一单项研究都没有发现单针头操作技术的血培养污染率显著增加。然而，随后的Meta分析提示单针头操作的血培养污染率为3.7%，相比之下，双针头操作的血培养污染率是2.0%。既然现行的护理操作标准仍然是单针头操作以减少职业针刺伤的危险，我们可能不得不容忍血培养污染率的轻微增加。
不当之处，请指正！
谢了！:liumangtu

缭绕

:fafdbag 还有几部分，谁上？加油啊！！！快出成果啦！

hdqiu

没有下文？希望老师们继续努力

尘埃69

桂花香 发表于 2007-9-24 18:23

                               
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我翻译第三部分：
THE PARADOX OF INCREASING NUMBERS OF CONTAMINANTS似非而是的污染增加
Despite numer ...

各位老师的英语水平让我钦佩！