成人血培养究竟需要采多少量血？

David

中秋节加餐啦:lol :lol :lol :haha


J Clin Microbiol. 2007 Sep 19; [Epub ahead of print]
Detection of bloodstream infections in adults: how many blood cultures are needed?

Lee A, Mirrett S, Reller LB, Weinstein MP.
Departments of Medicine and Pathology, Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903-1109; and Departments of Pathology and Medicine, Duke University Medical Center, Durham, North Carolina, 27710.

Background: Although several reports have shown that two to three 20-mL blood cultures are adequate for the detection of bacteremia and fungemia in adults, a recent study (Cockerill FR, et al. 2004. Clin Infect Dis 38:1724-30) found that 2 blood cultures detected only 80% of bloodstream infections and that 3 blood cultures detected 96% of episodes. We reviewed data at two university hospitals to determine whether the recent observations of Cockerill, et al. are applicable more widely. Methods: We assessed all blood cultures obtained from adult inpatients from 1 January 2004 through 31 December 2005 at Robert Wood Johnson University Hospital and Duke University Medical Center. All instances in which >/=3 blood cultures per patient were obtained during a 24 h period were included. The medical records of patients who met the inclusion criteria were reviewed retrospectively to determine the clinical significance of the positive blood culture (true infection vs. contamination). Data were analyzed to determine the cumulative sensitivity of blood cultures obtained sequentially during the 24 h time period. Results: Of 629 unimicrobial episodes with >/=3 blood cultures obtained during the 24 h period, 460 (73.1%) were detected with the first blood culture, 564 (89.7%) were detected with the first 2 blood cultures, 618 (98.2%) were detected with the first 3 blood cultures, and 628 (99.8%) were detected with the first 4 blood cultures. Of 351 unimicrobial episodes with >/=4 blood cultures obtained during the 24 h period, 257 (73.2%) were detected with the first blood culture, 308 (93.9%) were detected with the first 2 blood cultures; 340 (96.9%) were detected with the first 3 blood cultures, and 350 (99.7%) were detected with the first 4 blood cultures. Among unimicrobial episodes, Staphylococcus aureus was more likely to be detected with the first blood culture (approximately 90% detected with the first blood culture). There were 58 polymicrobial episodes in which >/= 3 blood cultures were obtained. Forty-seven (81.0%) were detected with the first blood culture, 54 (93.1%) were detected with the first 2 blood cultures, and 58 (100%) were detected with the first 3 blood cultures. Conclusion: The results of this study indicate that 2 blood cultures in a 24 h period will detect approximately 90% of bloodstream infections in adults. To achieve a detection rate of >99%, as many as 4 blood cultures may be needed. The previously held axiom that virtually all bloodstream infections can be detected with 2-3 blood cultures may no longer be valid but may also depend on the definition of the "first" blood culture obtained.

右手心

Detection of bloodstream infections in adults: how many blood cultures are needed?
成人的血液感染监测:需要多少血培养?
Background: Although several reports have shown that two to three 20-mL blood cultures are adequate for the detection of bacteremia and fungemia in adults, a recent study (Cockerill FR, et al. 2004. Clin Infect Dis 38:1724-30) found that 2 blood cultures detected only 80% of bloodstream infections and that 3 blood cultures detected 96% of episodes.
背景:虽然已经有一些文献报道成人适合2-3个20毫升的血培养去检测细菌和真菌,最近一个研究发现2个血培养检出血液感染率为80%,3个培养检出率为96%.
We reviewed data at two university hospitals to determine whether the recent observations of Cockerill, et al. are applicable more widely
我们回顾了2个教学医院的数据去看这个观测这个结论是否可以推广.
Methods: We assessed all blood cultures obtained from adult inpatients from 1 January 2004 through 31 December 2005 at Robert Wood Johnson University Hospital and Duke University Medical Center. All instances in which >/=3 blood cultures per patient were obtained during a 24 h period were included.
方法:我们从Robert Wood Johnson 和Duke教学医院采用了从2004年1月1日到2005年12月31日可得到的病人血培养标本作为研究对象.所有病例中包括24小时内有大于或等于3个血培养的病人.
The medical records of patients who met the inclusion criteria were reviewed retrospectively to determine the clinical significance of the positive blood culture (true infection vs. contamination).
回顾病例记录的选择标准,看阳性血培是否具有临床意义(真感染VS污染)
Data were analyzed to determine the cumulative sensitivity of blood cultures obtained sequentially during the 24 h time period.
数据分析决定血培养在一个周期24小时内的敏感度.

Results: Of 629 unimicrobial episodes with >/=3 blood cultures obtained during the 24 h period, 460 (73.1%) were detected with the first blood culture, 564 (89.7%) were detected with the first 2 blood cultures, 618 (98.2%) were detected with the first 3 blood cultures, and 628 (99.8%) were detected with the first 4 blood cultures.
结果:24小时内629例做了大于或者等于三个血培养组,在第一个血培养中有460个(73.1%)被检测出;564个(89.7%)在前两个血培养中检测出,618个(98.2%)在前三个血培养中检测出,628个(99.8%)在前四个血培养中检测出.
Of 351 unimicrobial episodes with >/=4 blood cultures obtained during the 24 h period, 257 (73.2%) were detected with the first blood culture, 308 (93.9%) were detected with the first 2 blood cultures;  340 (96.9%) were detected with the first 3 blood cultures, and 350 (99.7%) were detected with the first 4 blood cultures. 24小时内351例做了大于或者等于4个血培养的组别,257例(73.2%)在第一个血培养中检测出,308例(93.9%)在前两个血培养中检测出.340例(96.9%)在前三个血培养出检测出,350例在前四个血培养中检测出.
Among unimicrobial episodes, Staphylococcus aureus was more likely to be detected with the first blood culture (approximately 90% detected with the first blood culture).
在微生物检测中,金葡球菌在一个血培养中最容易被检测到.(大约90%在第一个中被检出).
There were 58 polymicrobial episodes in which >/= 3 blood cultures were obtained. Forty-seven (81.0%) were detected with the first blood culture, 54 (93.1%) were detected with the first 2 blood cultures, and 58 (100%) were detected with the first 3 blood cultures
在大于或等于3个血培养组别获得了58种微生物.47种(81%)于第一个血培养中检测出.54种在头两个血培养中检测出,在头三个血培养中检测出58种(100%).

Conclusion: The results of this study indicate that 2 blood cultures in a 24 h period will detect approximately 90% of bloodstream infections in adults. To achieve a detection rate of >99%, as many as 4 blood cultures may be needed. The previously held axiom that virtually all bloodstream infections can be detected with 2-3 blood cultures may no longer be valid but may also depend on the definition of the "first" blood culture obtained.
结论:这个研究结论表明24小时2个血培养能够检测出接近90%的成人血液感染.为了检出率大于99%,可能需要4个血培养.以前坚持的所有血液感染能够在2-3血液培养中检测出的原则可能不在适用,但可能仍然依据一个血培养结果确定.



时间仓促,请各位老师指教!

txzhou

谢谢右手心，这对我们很有帮助！

布衣

右手心，辛苦啦！请你吃月饼！



[ 本帖最后由 布衣 于 2007-9-25 21:20 编辑 ]

右手心

哈哈,谢谢哦!
还请老师纠错啊,感觉有些不通顺的

jyzmx

学习着，快乐着，进步着

怡之秋

这个研究结论表明24小时2个血培养能够检测出接近90%的成人血液感染.为了检出率大于99%,可能需要4个血培养.以前坚持的所有血液感染能够在2-3血液培养中检测出的原则可能不在适用,但可能仍然依据一个血培养结果确定.

这个结果值得和临床医生商榷。。。谢谢老师，问好。