背景及目的:以BacT/Alert血液培養機型評估第二與第三套血瓶在臨床檢驗上之必要性。 方法:從西元2000年一月到2001年六月,共自1,293位病人採血,置於21,112血瓶中以BacT/Alert血液培養機型培養。血液於不同時段採自疑似敗血症病人,分置於需氧及厭氧狀態下培養。血瓶出現陽性者進一步加以鑑定細菌種類。 結果:以BacT/Alert血液培養機型在一年半內共培養了21,112個血瓶,其中2,959瓶為陽性,包括1,381個(2,618瓶)擬分析的個案以及341瓶不擬分析的革蘭氏陽性桿菌與稀有菌株。擬分析的個案包含了779個開立一套血瓶培養、446個開立兩套不同時段的血瓶培養以及115個開立三套或三套以上不同時段之血瓶培養。其中開立兩套培養皆陽性的機率為50.9% (227/446),僅第一套血瓶陽性之機率是28.2% (126/446),僅第二套血瓶陽性之機率為20.9% (93/446)。再就115個開立三套的血瓶培養而言,其中第一套血瓶是陰性的比率佔了14.8% (17/115)。 結論:本項實驗結果顯示,開立超過一套的血液培養檢驗可增加10-20%的陽性機率。
Background and purpose: The value of second and third sets of blood culture for efficient detection of clinically relevant microorganisms was evaluated by an automated culture device: the BacT/Alert system. Methods: From January 2000 to June 2001, a total of 21,112 blood culture vessels from 1,293 patients were processed by the BacT/Alert system. Each patient suspected of septicemia had 20 mL of blood sample collected. These were aliquotted into aerobic and anaerobic culture vessels. All the blood culture sets processed by the BacT/Alert system that yielded positive results were analyzed and the microbe isolates were identified. Results: Fourteen percent (2,959/21,112) of the culture vessels yielded positive results. Among the test positive cultures, 1,381 episodes (2,618 vessels) were further identified. Gram-positive bacilli were suspected in 341 vessels and were not further studied. Among the 1,381 episodes, 779 episodes were diagnosed with one set of blood culture, 446 episodes with two sets and 115 episodes with three or more at intervals. Among the 446 episodes diagnosed with two sets, 50.9% (227/446) were test positive in both sets, while 28.2% (126/446) were positive in the first set and 20.9% (93/446) were positive in the second set of culture. Among the 115 episodes by three sets, the first set was negative in 14.8% (17/115). Conclusion: Our data demonstrate a 10-20% improvement of detection sensitivity when more than one blood specimens requested at intervals by the referring physician with subsequent culturing for detection of clinically relevant microorganisms.
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