血培养阴性血流感染影响因素及实验室检测研究进展

doi:10.3969/j.issn.1673-8640.2022.07.018

摘要/Abstract

摘要：

血流感染是指病原微生物侵入血流引起的播散感染,包括菌血症和败血症,可造成严重的临床后果,病死率较高。血培养作为诊断血流感染的金标准,具有很高的特异性。但采血前使用抗菌药物、采血量不足、血培养样本延迟上机处理等分析前因素,苛养微生物和无法常规培养的病原体的存在,导致血培养的阳性率较低。通过富集阳性血培养瓶中的病原体,利用基质辅助激光解吸电离飞行时间质谱（MALDI-TOF MS）技术和荧光原位杂交技术（FISH）进行病原鉴定,可有效提高血流感染的诊断效率。血清抗体检测、病原16S rRNA检测、实时荧光聚合酶链反应（PCR）、多重PCR、下一代测序（NGS）等技术能进一步提高血液标本中病原的检出率,是诊断血流感染的可靠方法。文章就血培养阴性结果的影响因素及血流感染实验室检测进展进行综述。

关键词: 血流感染, 血培养, 阴性, 病原体, 富集培养, 聚合酶链反应

Abstract:

Bloodstream infections refer to disseminated infections caused by pathogenic microorganisms invading bloodstream,including bacteremia and septicemia,which can lead to serious clinical consequence and high fatality rates. As the gold standard for the diagnosis of bloodstream infection,blood culture has high specificity,but an unsatisfactory positive rate and considerable patients with bloodstream infection have negative blood culture results. On one hand,the using of antibiotics before blood collection,insufficient blood volume,extended pre-analysis time and other factors should be accountable. On the other hand,there are some fastidious microorganisms needing prolonged incubation. The diagnostic efficiency of bloodstream infection can be improved by the enrichment of pathogens after reporting positive in culture flasks and rapid identification with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry（MALDI-TOF MS） and fluorescence in situ hybridization（FISH）. Serological test and molecular biotechnology,such as serum antibody determination,bacterium 16S rRNA,real-time fluorescence polymerase chain reaction（PCR）,multiplex PCR and next-generation sequencing（NGS）,can improve the detection rate of pathogens in bloodstream. This review focuses on the influence factors of negative blood culture and the progress of laboratory determination of bloodstream infection.

Key words: Bloodstream infection, Blood culture, Negative, Pathogen, Enrichment culture, Polymerase chain reaction

中图分类号:

R446.5

陈晗璐, 吴盛海. 血培养阴性血流感染影响因素及实验室检测研究进展[J]. 检验医学, 2022, 37(7): 688-694.

CHEN Hanlu, WU Shenghai. Influence factors of blood culture negative results and progress of pathogen detection in bloodstream infection[J]. Laboratory Medicine, 2022, 37(7): 688-694.

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