BacT/ALERT两种血培养系统8种血培养瓶对模拟菌血症标本检测能力的对比研究

doi:10.3877/cma.j.issn.2095-5820.2023.04.003

目的

比较需氧和兼性厌氧血培养瓶BacT/ALERT FA Plus、FA、PF Plus、PF、SA及厌氧和兼性厌氧血培养瓶BacT/ALERT FN Plus、FN、SN对模拟菌血症标本检测的差异；验证BacT/ALERT VIRTUO血培养仪监测血量的准确性。

方法

选取23种常见菌配制成菌悬液，在培养瓶中加入定量无菌缓冲液和健康人血以及菌悬液，分别放入两个血培养仪进行培养，比较平均检测时间（TTD）和阳性生长情况；向血培养瓶中注入定量磷酸缓冲盐溶液（PBS）后放入BacT/ALERT VIRTUO血培养仪，记录仪器监测量，并计算其与注入量的差异。

结果

除人型葡萄球菌和新型隐球菌外，8种血培养瓶对其余21种菌的阳性检出率均为100%；5种需氧和兼性厌氧瓶检测需氧和兼性厌氧微生物的平均TTD差异无统计学意义（P>0.05）；在检测厌氧和兼性厌氧菌方面，SN最快。在检测需氧和兼性厌氧菌、厌氧和兼性厌氧菌方面，BacT/ALERT VIRTUO血培养仪比国内使用较广泛的BacT/ALERT 3D血培养仪平均TTD分别缩短1.5~8 h和3~8 h；在检测真菌方面，两仪器间差异无统计学意义（P>0.05）。BacT/ALERT VIRTUO仪器监测血量和实际注入量之间差异无统计学意义（P>0.05）。

结论

5种需氧和兼性厌氧瓶在检测常见需氧和兼性厌氧菌血症标本方面的能力差异无统计学意义，SN在缩短厌氧和兼性厌氧菌血症检测时间方面优于FN和FN Plus；BacT/ALERT VIRTUO血培养仪能明显缩短菌血症标本的TTD，且在监测血量方面准确可靠。

关键词: 血培养, 培养基, 细菌, 血流感染

Objective

To compared the difference of aerobic and facultative anaerobic blood culture bottles BacT/ALERT FA Plus, FA, PF Plus, PF and SA, as well as anaerobic and facultative anaerobic bottles BacT/ALERT FN Plus, FN and SN in the detection of simulated bacteremia samples, and to verify the accuracy of monitoring blood volume with BacT/ALERT VIRTUO blood culture instrument.

Methods

23 kinds of bacteria were selected to prepare bacterial suspension. Healthy human blood and bacterial suspension were added into the bottles, and cultured in two blood culture systems respectively. The mean detection time (time-to-detect, TTD) and positive growth were compared. A certain amount of phosphate buffer saline (PBS) was injected into the blood culture bottles, and then placed in the BacT/ALERTVIRTUO blood culture instrument to get the monitoring volume, and calculate the difference between the injected volume and the monitoring volume.

Results

Except for Staphylococcus hominis and Cryptococcus neoformans, the positive detection rates of the other 21 strains were 100%. There was no significant difference in the average TTD time of the five kinds of aerobic bottles in the detection of aerobic and facultative anaerobic bacteria and fungi. For the detection of anaerobes and facultative anaerobes, SN bottle was the fastest. In the detection of aerobic and facultative anaerobes, anaerobic and facultative anaerobes, the average TTD time of BacT/ALERTVIRTUO blood culture instrument was shortened by 1.5~8 h and 3~8 h compared with BacT/ALERT 3D blood culture instrument, and the difference was statistically significant. The difference between the monitoring volume and the actual injection volume was no statistical difference.

Conclusions

There was no significant difference in the ability of five kinds of aerobic bottles to detect common bacteremia specimens. The anaerobic bottle SN is superior to FN and FN Plus bottles in shortening the detection time. BacT/ALERTVIRTUO blood culture instrument can significantly shorten the detection time of common bacteremia samples and is accurate and reliable in monitoring blood volume.

Key words: blood culture, culture medium, bacteria, bloodstream infection

表1 常见菌在不同血培养瓶和血培养仪TTD/h

分类	菌名	BacT/ALERT 3D					BacT/ALERT VIRTUO
分类	菌名	FA Plus	FN Plus	FA	FN	PF	FA Plus	FN Plus	SA	SN	PF Plus
需氧和兼性厌氧菌	金黄色葡萄球菌	17.8	22.3	16.6	16.6	69.4	10.8	22.0	11.8	9.8	11.5
	粪肠球菌	12.2	21.1	15.4	14.2	18.5	10.3	20.0	10.8	9.6	10.1
	人型葡萄球菌	19.0	40.3	22.6	N	26.6	17.7	28.8	19.8	13.6	18.5
	铅黄肠球菌	13.7	15.4	15.4	13.9	15.6	11.5	13.0	10.8	10.8	11.1
	无乳链球菌	15.1	\	14.2	\	15.1	15.8	\	14.3	\	10.6
	化脓链球菌	19.2	31.2	21.6	22.6	40.8	16.7	27.4	19.6	17.6	15.8
	大肠埃希菌	11.5	11.3	16.8	11.0	18.2	9.1	8.9	9.7	8.8	9.1
	肺炎克雷伯菌	12.2	12.7	12.5	12.2	13.4	9.3	10.3	10.0	9.7	10.1
	奇异变形杆菌	12.7	13.2	13.2	13.4	16.3	10.2	11.1	12.9	10.0	11.7
	阴沟肠杆菌	12.2	14.4	12.7	12.7	16.6	10.2	12.2	9.9	14.6	10.9
	嗜麦芽窄食单胞菌	27.4	\	24.2	\	25.2	25.7	\	23.2	\	25.5
	铜绿假单胞菌	17.3	\	17.3	\	17.3	16.1	\	14.5	\	17.3
	脑膜炎伊利沙白金菌	23.5	\	20.4	\	22.1	24.4	\	19.9	\	24.6
	鲍曼不动杆菌	11.3	\	15.4	\	14.9	9.1	\	10.8	\	9.8
	产酸克雷伯菌	12.5	13.2	13.0	12.7	13.2	11.0	11.0	11.3	9.7	11.5
	流感嗜血杆菌	16.3	19.9	14.2	46.3	14.2	14.3	14.1	22.0	17.5	11.9
	肺炎链球菌	13.4	13.4	12.7	61.7	13.7	9.4	12.7	10.2	10.8	8.9
厌氧菌	脆弱拟杆菌	\	37.2	\	107.5	\	\	34.8	\	33.9	\
真菌	葡萄牙念珠菌	24.7	\	24.7	\	24.7	26.0	\	25.2	\	24.8
	近平滑念珠菌	78.7	\	43.4	\	39.1	72.0	\	42.4	\	37.2
	新型隐球菌	94.1	\	137.5	\	N	93.6	\	N	\	66.4
	光滑念珠菌	16.3	\	20.6	\	18.5	16.1	\	20.7	\	29.8
	白色念珠菌	28.3	\	31.0	\	30.2	27.5	\	27.4	\	30.2

表1 常见菌在不同血培养瓶和血培养仪TTD/h

分类	菌名	BacT/ALERT 3D					BacT/ALERT VIRTUO
分类	菌名	FA Plus	FN Plus	FA	FN	PF	FA Plus	FN Plus	SA	SN	PF Plus
需氧和兼性厌氧菌	金黄色葡萄球菌	17.8	22.3	16.6	16.6	69.4	10.8	22.0	11.8	9.8	11.5
	粪肠球菌	12.2	21.1	15.4	14.2	18.5	10.3	20.0	10.8	9.6	10.1
	人型葡萄球菌	19.0	40.3	22.6	N	26.6	17.7	28.8	19.8	13.6	18.5
	铅黄肠球菌	13.7	15.4	15.4	13.9	15.6	11.5	13.0	10.8	10.8	11.1
	无乳链球菌	15.1	\	14.2	\	15.1	15.8	\	14.3	\	10.6
	化脓链球菌	19.2	31.2	21.6	22.6	40.8	16.7	27.4	19.6	17.6	15.8
	大肠埃希菌	11.5	11.3	16.8	11.0	18.2	9.1	8.9	9.7	8.8	9.1
	肺炎克雷伯菌	12.2	12.7	12.5	12.2	13.4	9.3	10.3	10.0	9.7	10.1
	奇异变形杆菌	12.7	13.2	13.2	13.4	16.3	10.2	11.1	12.9	10.0	11.7
	阴沟肠杆菌	12.2	14.4	12.7	12.7	16.6	10.2	12.2	9.9	14.6	10.9
	嗜麦芽窄食单胞菌	27.4	\	24.2	\	25.2	25.7	\	23.2	\	25.5
	铜绿假单胞菌	17.3	\	17.3	\	17.3	16.1	\	14.5	\	17.3
	脑膜炎伊利沙白金菌	23.5	\	20.4	\	22.1	24.4	\	19.9	\	24.6
	鲍曼不动杆菌	11.3	\	15.4	\	14.9	9.1	\	10.8	\	9.8
	产酸克雷伯菌	12.5	13.2	13.0	12.7	13.2	11.0	11.0	11.3	9.7	11.5
	流感嗜血杆菌	16.3	19.9	14.2	46.3	14.2	14.3	14.1	22.0	17.5	11.9
	肺炎链球菌	13.4	13.4	12.7	61.7	13.7	9.4	12.7	10.2	10.8	8.9
厌氧菌	脆弱拟杆菌	\	37.2	\	107.5	\	\	34.8	\	33.9	\
真菌	葡萄牙念珠菌	24.7	\	24.7	\	24.7	26.0	\	25.2	\	24.8
	近平滑念珠菌	78.7	\	43.4	\	39.1	72.0	\	42.4	\	37.2
	新型隐球菌	94.1	\	137.5	\	N	93.6	\	N	\	66.4
	光滑念珠菌	16.3	\	20.6	\	18.5	16.1	\	20.7	\	29.8
	白色念珠菌	28.3	\	31.0	\	30.2	27.5	\	27.4	\	30.2

表2 需氧和兼性厌氧瓶检测需氧和兼性厌氧菌模拟菌血症标本的TTD对比

血培养仪	血培养瓶	平均TTD/h
BacT/ALERT 3D	FA Plus	15.7±4.5
	FA	16.3±3.7
	PF	21.8±14.1
BacT/ALERT VIRTUO	FA Plus	13.6±5.3
	SA	14.2±4.7
	PF Plus	13.5±5.1

表2 需氧和兼性厌氧瓶检测需氧和兼性厌氧菌模拟菌血症标本的TTD对比

血培养仪	血培养瓶	平均TTD/h
BacT/ALERT 3D	FA Plus	15.7±4.5
	FA	16.3±3.7
	PF	21.8±14.1
BacT/ALERT VIRTUO	FA Plus	13.6±5.3
	SA	14.2±4.7
	PF Plus	13.5±5.1

表3 需氧和兼性厌氧瓶在VIRTUO和3D血培养仪平均TTD对比（VIRTUO缩短时间h/P值）

BacT/ALERT VIRTUO	BacT/ALERT 3D
BacT/ALERT VIRTUO	FA Plus	FA	PF
FA Plus	2.0/0.000 1	2.7/0.002 3	8.2/0.026 3
SA	1.5/0.026 5	2.1/0.013 1	7.6/0.039 9
PF Plus	2.2/0.000 1	2.8/0.000 8	8.3/0.026 3

表3 需氧和兼性厌氧瓶在VIRTUO和3D血培养仪平均TTD对比（VIRTUO缩短时间h/P值）

BacT/ALERT VIRTUO	BacT/ALERT 3D
BacT/ALERT VIRTUO	FA Plus	FA	PF
FA Plus	2.0/0.000 1	2.7/0.002 3	8.2/0.026 3
SA	1.5/0.026 5	2.1/0.013 1	7.6/0.039 9
PF Plus	2.2/0.000 1	2.8/0.000 8	8.3/0.026 3

表4 需氧和兼性厌氧瓶检测真菌模拟菌血症标本的TTD对比

血培养仪	血培养瓶	平均TTD/h
BacT/ALERT 3D	FA Plus	48.4±35.3
	FA	51.5±48.9
	PF	28.1±8.8
BacT/ALERT VIRTUO	FA Plus	47.0±33.8
	SA	28.9±9.4
	PF Plus	37.7±16.7

表4 需氧和兼性厌氧瓶检测真菌模拟菌血症标本的TTD对比

血培养仪	血培养瓶	平均TTD/h
BacT/ALERT 3D	FA Plus	48.4±35.3
	FA	51.5±48.9
	PF	28.1±8.8
BacT/ALERT VIRTUO	FA Plus	47.0±33.8
	SA	28.9±9.4
	PF Plus	37.7±16.7

表5 厌氧和兼性厌氧瓶检测厌氧和兼性厌氧菌模拟菌血症标本的TTD对比

血培养仪	血培养瓶	平均TTD/h
BacT/ALERT 3D	FA Plus	20.4±9.8
	FN	21.6±16.7
BacT/ALERT VIRTUO	FN Plus	17.4±8.4
	SN	13.6±16.8

表5 厌氧和兼性厌氧瓶检测厌氧和兼性厌氧菌模拟菌血症标本的TTD对比

血培养仪	血培养瓶	平均TTD/h
BacT/ALERT 3D	FA Plus	20.4±9.8
	FN	21.6±16.7
BacT/ALERT VIRTUO	FN Plus	17.4±8.4
	SN	13.6±16.8

表6 厌氧和兼性厌氧瓶在VIRTUO和3D血培养仪平均TTD对比（VIRTUO缩短时间h/P值）

BacT/ALERT VIRTUO	BacT/ALERT 3D
BacT/ALERT VIRTUO	FN Plus	FN
FN Plus	3.0/0.002 7	4.2/0.225 7
SN	6.8/0.005 8	8.0/0.065 1

表6 厌氧和兼性厌氧瓶在VIRTUO和3D血培养仪平均TTD对比（VIRTUO缩短时间h/P值）

BacT/ALERT VIRTUO	BacT/ALERT 3D
BacT/ALERT VIRTUO	FN Plus	FN
FN Plus	3.0/0.002 7	4.2/0.225 7
SN	6.8/0.005 8	8.0/0.065 1

表7 实际注入量和监测量对比

实际注入量/ml	监测量/ml	P值
3	2~4	0.363 2
5	3~7	1.000 0
10	8~12	0.545 1

表7 实际注入量和监测量对比

实际注入量/ml	监测量/ml	P值
3	2~4	0.363 2
5	3~7	1.000 0
10	8~12	0.545 1

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Comparative study on the detection ability of BacT/ALERT two blood culture systems and eight blood culture bottles for simulated bacteremia specimens

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Comparative study on the detection ability of BacT/ALERT two blood culture systems and eight blood culture bottles for simulated bacteremia specimens