目的 研究保留静脉导管时诊断导管相关性血流感染(CRBSI)的检验方法,为减少临床不必要的静脉导管拨除提供实验室诊断依据。方法 从2009年11月起,华山医院中心重症监护室临床医生根据患者的临床表现将患者分为需要保留导管者和拔除导管者,保留导管者分别从外周静脉和中心静脉导管各抽血1套(1瓶厌氧培养和1瓶需氧培养)进行血培养,另外再分别抽取3 mL血进行血定量培养,必须拔除导管时,拔出导管并采集2套外周静脉血送检。结果 50例保留导管送检病例中,27例检出细菌生长,其中临床加实验室综合判定为CRBSI 10例,导管保留法正确判定8例,2例判定为定植;综合判定为定植者7例,导管保留法正确判定6例,1例阴性;1例污染。血定量培养仅见在加有中和剂的巧克力平板上有细菌生长。结论 分别从外周和中心静脉抽血进行血培养和血定量培养能够可以准确检出CRBSI及导管细菌定植。

Objective To study the diagnosis of catheter-related bloodstream infection (CRBSI) by retaining intravascular catheter methods, and to provide a method to decrease the unnecessary removing of the intravascular catheter for clinician.Methods According to the patient's clinical symptoms, the clinician in the Central Intensive Care Unit of Huashan Hospital classified the patients into retaining and removeing the catheter for diagnosing the CRBSI from November in 2009. In the case of retaining the catheter, a set of blood (a bottle of aerobic blood culture and a bottle of anaerobic blood culture) was taken from peripheral vein and central venous catheter to perform blood culture. In the case of removing the catheter, the another 3 mL blood sample was collected and performed quantitative blood culture, and 2 sets of blood were send to determination.Results The 27 of 50 episodes of retaining catheter specimens were detected the growth of bacteria. The 10 of them were CRBSI by laboratory evidence plus clinical diagnosis. The 8 episodes were CRBSI, and 2 episodes were determined as bacterial colonization by retaining catheter methods. The 7 episodes were determined as bacterial colonization by overall estimation method, 6 episodes were correctly diagnosed, 1 episode was negative by retaining catheter methods, and 1 episode was determined as contamination. Quantitative blood culture had growth of bacteria only in chocolate medium.Conclusions The methods retaining the venous catheter can accurately detect the CRBSI.