Nishiyama Hiroyuki
Central Clinical Laboratories, Surugadai Nihon University Hospital.
Rinsho Biseibutshu Jinsoku Shindan Kenkyukai Shi. 2003;13(2):137-45.
To investigate the present state and the disadvantages of rapid diagnosis methods in clinical microbiology in Japan, We have conducted a questionnaire survey of 360 medical facilities accredited by the Japanese Association for Rapid Method and Automation in Microbiology (JARMAM). Major rapid diagnosis methods being used in clinical microbiology are, in the order of its use rate, influenza virus, adenovirus, Mycobacterium tuberculosis, Clostridium difficile toxin A, Rotavirus, hepatitis B virus, group A Streptococcus, RS virus, hepatitis C virus antibody. The fact found by this survey is that there is some gap between two groups, as one group views that the result of rapid diagnosis method can be considered as the final, another views that it is a supplementary diagnosis under conventional methods such as culturing. Some problems related to rapid diagnosis methods are also pointed out; how to interpret and report a test result obtained by the rapid diagnosis method when it is different from that of culture method, it can not perform antibiotic sensitivity tests, a problem of non-specific reaction, comparatively higher cost of rapid diagnosis kits. This survey finds that rapid diagnosis methods have greatly contributed to early medical treatment and appropriate therapy with its quickness, such as the use of rapid diagnosis kits for bacterial meningitis or viral infectious diseases requiring clinical urgency is highly necessitated even though some problems mentioned above exist.
为了调查日本临床微生物学中快速诊断方法的现状及不足之处,我们对日本微生物快速检测方法与自动化协会(JARMAM)认可的360家医疗机构进行了问卷调查。临床微生物学中使用的主要快速诊断方法,按使用率排序依次为:流感病毒、腺病毒、结核分枝杆菌、艰难梭菌毒素A、轮状病毒、乙型肝炎病毒、A组链球菌、呼吸道合胞病毒、丙型肝炎病毒抗体。本次调查发现的一个事实是,在两组人员之间存在一些差异,一组认为快速诊断方法的结果可被视为最终结果,另一组则认为它是传统方法(如培养法)下的补充诊断。同时也指出了一些与快速诊断方法相关的问题;当快速诊断方法获得的检测结果与培养法不同时,如何解释和报告该结果,其无法进行抗生素敏感性试验,存在非特异性反应问题,快速诊断试剂盒成本相对较高。本次调查发现,快速诊断方法凭借其快速性,对早期治疗和恰当治疗做出了巨大贡献,例如对于细菌性脑膜炎或需要临床紧急处理的病毒感染性疾病,即使存在上述一些问题,使用快速诊断试剂盒也是非常必要的。