bacteremiaandbloodculture菌血症和血液培养ppt课件

,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,*,Bacteremia and Best Practices in Blood Culture,首都医科大学附属北京朝阳医院,感染和临床微生物科,曹彬,Bacteremia and Best Practices,定义,SIRS,：全身反应具有以下两个或多个症状：,体温,38.3,o,C,，或,90/,分钟,呼吸率,30/,分钟,白细胞,12,000,；,10%,SEPSIS,（败血症、脓毒症）：感染,SIRS,Severe sepsis,：,sepsis,器官功能损害,Septic shock,：低灌注表现,定义SIRS：全身反应具有以下两个或多个症状：,SYSTEMIC INFLAMMATORY RESPONSE(SIRS),全身的炎性反应,INFECTION,SEPSIS,感染 败血症,SIRS,BACTEREMIA,菌血症,TRAUMA,外伤,PANCREATITIS,胰腺炎,BURNS,烧伤,OTHER,其它,FUNGEMIA,真菌血症,PARASITEMIA,寄生虫血症,VIREMIA,病毒血症,OTHER,其它,SYSTEMIC INFLAMMATORY RESPONSE,Hours to Days,*,Rangel-Frausta,1995 JAMA 273:117-23,%,+,Blood,Cultures,17,25,69,%,Mortality,Hours to Days*Rangel-Frausta,Blood Cultures to Detect Sepsis,血培养检测败血症,Positivity Rates(%),阳性百分率,Sepsis,（败血症）,15-20,Severe Sepsis,（严重败血症）,25-35,Septic Shock,（败血症休克）,50 70,Therefore,also,need to culture other relevant sites(urine,sputum,wound,etc),同时还需要对其它相关部位进行培养检测（尿液、痰、伤口等）,Blood Cultures to Detect Sepsi,定义,菌血症,（,BACTEREMIA,）,：血液中有细菌存在并可通过培养证实,一过性,间歇性,持续性,定义菌血症（BACTEREMIA）：血液中有细菌存在并可通,菌血症的分类,BSOP 3715,一过性菌血症,（,transient）：,持续仅数分钟,感染组织、粘膜表面、管定居的微生物,钻牙、导尿、挤压毛囊、,通过植入、手术进入,多次一过性菌血症,（,intermittent）,未引流的腹腔脓肿,肺炎球菌肺炎,持续性,菌血症,（,Continuoys）,感染性心内膜炎,化脓性 凝血性脉管炎,防御低下的严重感染,菌血症的分类 BSOP 3715一过性菌血症（trans,明确血培养的临床意义,血培养查病原菌对诊断以下疾病很重要：,菌血症,感染性心内膜炎,临床不明原因感染,假体植入后感染人工关节、人工瓣膜,静脉导管相关性菌血症,Septic,关节炎,肺炎,血培养是最好的工具帮助它们用药、减少死亡率,明确血培养的临床意义血培养查病原菌对诊断以下疾病很重要：,菌血症的来源,CUMITECH,，,ASM,，,NW,菌血症的来源 CUMITECH，ASM，NW,TOP 10 CLINICALLY-SIGNIFICANT MICROORGANISMS,有临床意义的前,10,位细菌,(1990-1993):CID 1997,TOP 10 CLINICALLY-SIGNIFICANT,Top Ten Blood Culture Isolates(1996-1997),前,10,位血培养分离的菌株（,1996,1997,）,Cockerill,et al.,CID 2004,Top Ten Blood Culture Isolates,北京朝阳医院菌血症分布（,2000,2007,）,北京朝阳医院菌血症分布（20002007）,北京朝阳医院前十位菌血症（,2000,2007,）,2000,2001,2002,2003,2004,2005,2006,大肠,19,30,37,27,29,54,39,凝固酶阴性葡萄,18,16,30,15,23,29,60,金葡,11,9,7,6,15,14,20,肺克,3,10,9,13,5,10,10,肠球,7,9,14,16,10,20,28,绿脓,6,7,9,3,8,6,9,不动,4,1,7,19,7,7,15,嗜麦芽,14,3,2,2,4,15,阴沟,4,0,3,3,11,7,念珠,北京朝阳医院前十位菌血症（20002007）2000200,CLSI,血培养的,原则,和操作程序推荐,（,Proposed）,指南,2006年10月出版：,M47-P,只是协商后的推荐稿（,consensus proposed）,收集来自全球的评论和建议,收集截止日期：2007年1月29日,下一步要出版投票通过的试行指南,2005-09-08,出版：,BSOP 37 Issue 5,http:/www.hpa-standards.org.uk/pdf_sops.asp,INVESTIGATION OF BLOOD CULTURES(FOR ORGANISMS OTHER THAN MYCOBACTERIUM SPESIES),参编单位：,医学微生物协会,临床微生物协会 苏格兰微生物协会,IBMS,Welsh,微生物协会,统一由卫生防护署（,Health Protection Agency,）,领导,英国,HPA,的血培养的研究及操作程序,CLSI血培养的原则和操作程序推荐（Proposed）指南2,Optimal Recovery of Organisms in Blood Culture,血培养的最佳检出率,Special Reference to CLSI M47-P,Optimal Recovery of Organisms,Key Points,（关键点）,Timing of drawing blood culture,（采血时间）,Number of blood culture sets,（采血次数）,Volume of blood inoculated,（接种血液数量）,Use of resin media,（使用含树脂培养瓶）,Key Points（关键点）Timing of drawi,0,30,60,Time(min),Temp,体温,Chills,寒战,Blood Cultures,血培养,BACTEREMIA,LEVEL,菌血症的水平,03060Time(min)TempChillsBlood,What is the best time to draw blood cultures?,采集血培养的最佳时间？,Answer:,Draw blood cultures as close as possible to the episode of chills or fever.Do NOT delay,as recovery of microorganisms diminishes with time after the fever spike.,答案：,采集血培养应尽可能在患者寒战或发热时，不要耽搁。因为超过发热峰值后，病原菌的检出率会随之降低。,What is the best time to draw,How far apart should the sets be collected?,每次采集血培养的间隔时间？,Answer:,1.Blood culture sets should be obtained,within 5 minutes of each other,since the reticulendothelial system will clear both transient and intermittent bacteremias within 15-30 minutes,(CLSI states they should be obtained simultaneously,or over a short timeframe),2.In suspected subacute infective endocarditis,draw 3 blood culture sets spaced 1 hour apart,(CLSI lists this as an option to consider),答案：,每份血培养间隔应不超过,5,分钟，因为网状内皮系统对于一过性菌血症和间歇性菌血症在,15,30,分钟内可清除（,CLSI,规定每份血培养应同时获得，或尽可能短的时间内）,对怀疑亚急性感染性心内膜炎，间隔,1,小时，连续采集,3,份血培养,How far apart should the sets,“,How many blood culture sets do I need to draw?”,需要采集多少份血培养？,“How many blood culture sets d,NUMBER OF SETS,Weinstein MP,Reller LB,Murphy JR,and Lichtenstein KA Rev Inf Dis 5:35,1983,NUMBER OF SETSWeinstein MP,Re,Cockerill,CID 2004,Cockerill,CID 2004,How many blood culture sets should be drawn?,应该采集多少份血培养？,Answer:,At least,2 and preferably 3 blood culture sets should be drawn on each patient per episode.,(CLSI states 2-3 blood culture sets),NEVER draw only 1 blood culture set during the initial evaluation of a septic patient.,(CLSI emphasizes this point),Note:A“set”is defined by the number of independent venipunctures,答案：,每名患者应至少采集,2,份血培养，最好为,3,份（,CLSI,规定采集,2,3,份血培养）,在一名败血症患者初期诊断时，,绝不能,只采集,1,份血培养（,CLSI,强调了此观点）,注意：,1“,份”是指一次静脉穿刺,How many blood culture sets sh,CLINICAL SIGNIFICANCE OF,Staphylococcus epidermidis,表皮葡萄球菌的临床意义,Positive Predictive Value(%),55,20,98,5,Tokars,JI.Clin Infect Dis 2004;39:333,CLINICAL SIGNIFICANCE OF Staph,“,How much blood should I draw from the patient?”,患者应采集多少血液？,“How much blood should I draw,Effect of Volum