超声波裂解法在中心静脉导管尖端行细菌培养中的敏感性研究
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摘要
目的观察超声波裂解法应用在中心静脉导管尖端培养的效果,探讨该方法在诊断导管相关性血流感染中的作用和价值。方法对122份中心静脉导管尖端标本进行细菌培养。所有标本均来自我院ICU病房住院并接受中心静脉导管留置术治疗的患者。所有标本均同时应用导管尖端滚动培养法和超声波裂解液血培养瓶增菌培养法进行细菌培养,并对两种培养方法的敏感性和培养效率进行对比分析。结果 2种培养方法中超声波裂解液血培养瓶增菌培养法有35例导管尖端培养结果为阳性,得到37株病原菌。导管尖端滚动培养法敏感性较低,出现17例标本培养结果为阳性,只培养得到病原菌18株。2种培养方法的培养敏感性之间差异有统计学意义(P<0.05),超声波裂解培养法的敏感性明显好于导管尖端滚动培养方法(P<0.05)。超声波裂解液培养法的培养阳性生长时间明显缩短,导管尖端的细菌培养效率明显好于滚动接种培养法(P<0.05)。结论应用超声波裂解液培养法相比导管尖端滚动培养法表现出较好的敏感性,并且超声波裂解培养法表现出更好的培养效率。研究结果显示,当前中心静脉导管尖端培养可能存在一定的假阴性结果。我院导管相关性血流感染确诊率可能比实际情况偏低。
Objective To observe the effects of sonication cultures of central venous catheter tip treated by supersonic wave clearage in bacterial culture,and to explore the effects and application value of the method in diagnosis of catheter lineassociated bloodstream infections(CLABSI).Methods A total of 122 central venous catheter tip specimens coming from the patients who were treated by central venous catheter detaining operation in our hospital from July 2015 to October 2016 were taken for bacterial culture.All the specimens were treated simultaneously by conventional catheter tip cultures and sonication cultures for bacterial culture,then the sensitivity and culture efficiency were observed and compared between the two methods.Results The sensitivity of sonication fluid inoculating into blood culture bottles method was higher in the two culture methods,in which,35 cases were positive and obtained 37 strains of pathogens.The sensitivity of catheter tip rolling culture method was lower,which only obtained 18 strains of pathogens,there was significant difference in culture sensitivity between the two culure methods(P<0.05),and the sensitivity of supersonic wave clearage culture method was superior to that of catheter tip rolling culture method(P<0.05).Moreover the culture positive growth time of supersonic wave clearage culture method was significantly shorter than that of catheter tip rolling culture method,and the culture efficiency of supersonic wave clearage culture method was superior to that of catheter tip rolling culture method(P<0.05).Conclusion The sensitivity and culture efficiency of supersonic wave clearage culture method are superior to those of catheter tip rolling culture method.
Objective To observe the effects of sonication cultures of central venous catheter tip treated by supersonic wave clearage in bacterial culture,and to explore the effects and application value of the method in diagnosis of catheter lineassociated bloodstream infections(CLABSI).Methods A total of 122 central venous catheter tip specimens coming from the patients who were treated by central venous catheter detaining operation in our hospital from July 2015 to October 2016 were taken for bacterial culture.All the specimens were treated simultaneously by conventional catheter tip cultures and sonication cultures for bacterial culture,then the sensitivity and culture efficiency were observed and compared between the two methods.Results The sensitivity of sonication fluid inoculating into blood culture bottles method was higher in the two culture methods,in which,35 cases were positive and obtained 37 strains of pathogens.The sensitivity of catheter tip rolling culture method was lower,which only obtained 18 strains of pathogens,there was significant difference in culture sensitivity between the two culure methods(P<0.05),and the sensitivity of supersonic wave clearage culture method was superior to that of catheter tip rolling culture method(P<0.05).Moreover the culture positive growth time of supersonic wave clearage culture method was significantly shorter than that of catheter tip rolling culture method,and the culture efficiency of supersonic wave clearage culture method was superior to that of catheter tip rolling culture method(P<0.05).Conclusion The sensitivity and culture efficiency of supersonic wave clearage culture method are superior to those of catheter tip rolling culture method.
引文
1 O’Grady NP,Alexander M,Burns LA,et al.Guidelines for the prevention of intravascular catheter-related infections,2011,59:e162-193.
2 Gavhane YN,Shete AS,Bhagat AK,et al.Solid tumors:facts,challenges and solutions.International Journal of Pharma Sciences&Research,2011,2:1-12.
3梁蓓,姜利,刘淑梅,等.首都医科大学附属复兴医院2012年住院患者血流感染分析.中华内科杂志,2016,55:609-612.
4李骏,喻莉,杨军辉,等.ICU内中心静脉导管相关性血流感染的调查及危险因素分析.重庆医学,2015,44:495-497.
5 Maki DG,Jarrett F,Sarafin HW.A semiquantitative culture method for identification of catheter-related infection in the burn patient.Journal of Surgical Research,1977,22:513-520.
6 Trampuz A,Piper KE,Jacobson MJ,et al.Sonication of removed hip and knee prostheses for diagnosis of infection.New England Journal of Medicine,2007,357:654-663.
7 O’Grady NP,Gerberding JL,Weinstein RA,et al.Patient safety and the science of prevention:the time for implementing the Guidelines for the prevention of intravascular catheter-related infections is now.//Mythology,the voyage of the hero/.Harper&Row,1981.291-292.
8 Lewis K.Riddle of biofilm resistance.Antimicrobial Agents&Chemotherapy,2001,45:999-1007.
9 Raad II,Mohamed JA,Reitzel RA,et al.The prevention of biofilm colonization by multidrug-resistant pathogens that cause ventilatorassociated pneumonia with antimicrobial-coated endotracheal tubes.Biomaterials,2011,32:2689-2694.
10 Donlan RM,Costerton JW.Biofilms:survival mechanisms of clinically relevant microorganisms.Clinical Microbiology Reviews,2002,15:167-193.
11 Rani SA,Pitts B,Beyenal H,et al.Spatial patterns of DNA replication,protein synthesis,and oxygen concentration within bacterial biofilms reveal diverse physiological states.Journal of Bacteriology,2007,189:4223-4233.
12 Hoenders CSM,Harmsen MC,Van Luyn MJA.The local inflammatory environment and microorganisms in“aseptic”loosening of hip prostheses.Journal of Biomedical Materials Research Part B Applied Biomaterials,2008,86B:291-301.
13 Donlan RM.Biofilm formation:a clinically relevant microbiological process.Clinical Infectious Diseases,2001,33:1387-1392.
14谢红梅,胡必杰,周昭彦,等.铜绿假单胞菌生物膜形成影响因素的研究.中华医院感染学杂志,2007,17:1475-1477.
15 Trampuz A,Piper KE,Jacobson MJ,et al.Sonication of removed hip and knee prostheses for diagnosis of infection.New England Journal of Medicine,2007,357:654-663.
16 Joyce E,Al-Hashimi A,Mason TJ.Assessing the effect of different ultrasonic frequencies on bacterial viability using flow cytometry.Journal of Applied Microbiology,2011,110:862-870.
17 Rohner P,Pepey B,Auckenthaler R.Comparison of BacT/Alert with Signal blood culture system.Journal of Clinical Microbiology,1995,33:313-317.
18 Zadroga R,Williams DN,Gottschall R,et al.Comparison of 2 blood culture media shows significant differences in bacterial recovery for patients on antimicrobial therapy.Clinical Infectious Diseases An Official Publication of the Infectious Diseases Society of America,2013,56:790-797.
19 Roh KH,Kim JY,Kim HN,et al.Evaluation of BACTEC Plus aerobic and anaerobic blood culture bottles and BacT/Alert FAN aerobic and anaerobic blood culture bottles for the detection of bacteremia in ICUpatients.Diagnostic Microbiology&Infectious Disease,2012,73:239-242.
20 Peterson LR,Smith BA.Nonutility of Catheter Tip Cultures for the Diagnosis of Central Line-Associated Bloodstream Infection.Clinical Infectious Diseases,2014,60:113-120.
21 Semel F.Are Cultures of Central Line Intravascular Catheter Tips Valuable in the Management of Central Line-Associated Bloodstream Infection(CLABSI)//IDWeek 2013 Meeting of the Infectious Diseases Society of America.2013.
22 Parienti JJ,Du CD,Mermel LA.Complications of Central Venous Catheterization.New England Journal of Medicine,2016,374:1489-1492.
2 Gavhane YN,Shete AS,Bhagat AK,et al.Solid tumors:facts,challenges and solutions.International Journal of Pharma Sciences&Research,2011,2:1-12.
3梁蓓,姜利,刘淑梅,等.首都医科大学附属复兴医院2012年住院患者血流感染分析.中华内科杂志,2016,55:609-612.
4李骏,喻莉,杨军辉,等.ICU内中心静脉导管相关性血流感染的调查及危险因素分析.重庆医学,2015,44:495-497.
5 Maki DG,Jarrett F,Sarafin HW.A semiquantitative culture method for identification of catheter-related infection in the burn patient.Journal of Surgical Research,1977,22:513-520.
6 Trampuz A,Piper KE,Jacobson MJ,et al.Sonication of removed hip and knee prostheses for diagnosis of infection.New England Journal of Medicine,2007,357:654-663.
7 O’Grady NP,Gerberding JL,Weinstein RA,et al.Patient safety and the science of prevention:the time for implementing the Guidelines for the prevention of intravascular catheter-related infections is now.//Mythology,the voyage of the hero/.Harper&Row,1981.291-292.
8 Lewis K.Riddle of biofilm resistance.Antimicrobial Agents&Chemotherapy,2001,45:999-1007.
9 Raad II,Mohamed JA,Reitzel RA,et al.The prevention of biofilm colonization by multidrug-resistant pathogens that cause ventilatorassociated pneumonia with antimicrobial-coated endotracheal tubes.Biomaterials,2011,32:2689-2694.
10 Donlan RM,Costerton JW.Biofilms:survival mechanisms of clinically relevant microorganisms.Clinical Microbiology Reviews,2002,15:167-193.
11 Rani SA,Pitts B,Beyenal H,et al.Spatial patterns of DNA replication,protein synthesis,and oxygen concentration within bacterial biofilms reveal diverse physiological states.Journal of Bacteriology,2007,189:4223-4233.
12 Hoenders CSM,Harmsen MC,Van Luyn MJA.The local inflammatory environment and microorganisms in“aseptic”loosening of hip prostheses.Journal of Biomedical Materials Research Part B Applied Biomaterials,2008,86B:291-301.
13 Donlan RM.Biofilm formation:a clinically relevant microbiological process.Clinical Infectious Diseases,2001,33:1387-1392.
14谢红梅,胡必杰,周昭彦,等.铜绿假单胞菌生物膜形成影响因素的研究.中华医院感染学杂志,2007,17:1475-1477.
15 Trampuz A,Piper KE,Jacobson MJ,et al.Sonication of removed hip and knee prostheses for diagnosis of infection.New England Journal of Medicine,2007,357:654-663.
16 Joyce E,Al-Hashimi A,Mason TJ.Assessing the effect of different ultrasonic frequencies on bacterial viability using flow cytometry.Journal of Applied Microbiology,2011,110:862-870.
17 Rohner P,Pepey B,Auckenthaler R.Comparison of BacT/Alert with Signal blood culture system.Journal of Clinical Microbiology,1995,33:313-317.
18 Zadroga R,Williams DN,Gottschall R,et al.Comparison of 2 blood culture media shows significant differences in bacterial recovery for patients on antimicrobial therapy.Clinical Infectious Diseases An Official Publication of the Infectious Diseases Society of America,2013,56:790-797.
19 Roh KH,Kim JY,Kim HN,et al.Evaluation of BACTEC Plus aerobic and anaerobic blood culture bottles and BacT/Alert FAN aerobic and anaerobic blood culture bottles for the detection of bacteremia in ICUpatients.Diagnostic Microbiology&Infectious Disease,2012,73:239-242.
20 Peterson LR,Smith BA.Nonutility of Catheter Tip Cultures for the Diagnosis of Central Line-Associated Bloodstream Infection.Clinical Infectious Diseases,2014,60:113-120.
21 Semel F.Are Cultures of Central Line Intravascular Catheter Tips Valuable in the Management of Central Line-Associated Bloodstream Infection(CLABSI)//IDWeek 2013 Meeting of the Infectious Diseases Society of America.2013.
22 Parienti JJ,Du CD,Mermel LA.Complications of Central Venous Catheterization.New England Journal of Medicine,2016,374:1489-1492.