血培养中污染菌和致病菌判断

Click to edit Master title style,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master title style,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master title style,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master title style,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master title style,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,血培养中污染菌的鉴别,1.,血培养污染的主要原因,皮肤正常菌群是血培养污染最常见的细菌，说明皮肤消毒不彻底和采血技术不当。,2.,血培养污染菌的主要来源,静脉穿刺时，因局部皮肤消毒不全，细菌随针刺带入被检血液而被培养出来。,长期留置血管导管的患者，其导管长期暴露在皮肤外界，而造成外界皮肤菌群的移生，在经导管采血过程中将导管内的移生细菌带入被检血液而被培养出来。,3,常见的血培养污染菌,3.1,造成血液培养污染的菌丛绝大多数为革兰氏阳性菌。,3.2,革兰氏阳性菌中,造成污染的机率远大于感染者,包括,:,凝固酶阴性的葡萄球菌、,芽孢杆菌种,、棒状杆菌及其它革兰阳性杆菌。,凝固酶阴性的葡萄球菌从过去以来一直是所有血液培养中,CNS,亦是最常出现菌种,也是血液培养污染最为常见菌种。,4.,血培养污染菌鉴别依据,血培养污染的鉴别主要依靠以下几个方面：微生物鉴定、阳性检出时间，重复培养结果以及临床特征（体温，白细胞，,PCT,，内毒素等）,其中判断价值最大的是：,PCT,，,（由药物等因素所致，国内文献报道高浓度的头孢他啶可使大鼠产生较少的,PCT,，牛磺酸可减少婴幼儿体外循环下,PCT,的释放,PCT,当,PCT,水平不高，而临床不能排除血流感染时，应结合,c,反应蛋白和白细胞计数等综合判定。,1.,体温：,3836,2.WBC:1*109/L,(,可以在病历中查到,),3.,降钙素原（最重要的判断依据）,疾 病 浓度（,ug/L,）,慢性炎症，自身免疫障碍,病毒性感染，如急性乙肝,轻度或局部细菌性感染,肺炎,0.510,全身炎症反应综合症，复合性损伤，烧伤,0.52,严重细菌感染，脓毒症多器官衰竭,2,（通常,10100,）,4.,超敏,CRP,5.,内毒素,观察一组血培养瓶中的阳性瓶数目、并以此来判定是病原菌还是污染菌,这种方法也已被采用。,双瓶双套中的一瓶报阳（污染）,单套双瓶中的一瓶报阳（无法判断是否污染，如果是厌氧瓶报警，需要染色判断是否是厌氧菌感染。）,.,报阳时间：菌血症时，血液含菌量越大，所以生长时间较快，报警时间越短,(,多数在,48,小时内报警,),当分离出的微生物为金黄色葡萄球菌、肺炎克雷伯菌、大肠埃希菌以及其他肠杆菌科细菌、铜绿假单胞菌、白色念珠菌时，90%以上是血流感染病原菌。分离出化脓性链球菌、无乳链球菌、产单核李斯特菌、脑膜炎奈瑟菌、淋病奈瑟菌、流感嗜血杆菌、脆弱拟杆菌其他假丝酵母菌和新型隐球菌时，污染的肯能性更低，相反棒状杆菌、微球菌、芽孢杆菌、丙酸杆菌、草绿色链球菌和凝固酶阴性葡萄球菌等很少是菌血症的病原菌。,有疑问时，多与临床沟通，共同学习，共同进步。,