Kirby James E, Delaney Meghan, Qian Qinfang, Gold Howard S
Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Arch Pathol Lab Med. 2009 Jan;133(1):93-6. doi: 10.5858/133.1.93.
The optimal use of dedicated fungal and mycobacterial blood culture bottles, such as the BACTEC Myco/F Lytic bottle, has not been well defined in clinical practice.
To compare the performance of Myco/F Lytic and standard blood culture in clinical practice in an urban tertiary care hospital setting and to implement a strategy for optimal use of Myco/F Lytic culture.
Retrospective review of laboratory records.
Myco/F Lytic culture did not increase detection of yeasts. Nor did it decrease time to detection except for Candida glabrata, where mean time to positivity dropped from 2.6 +/- 1.1 days in standard to 1.8 +/- 0.8 days in Myco/F Lytic culture. Therefore, an algorithm was developed in which Myco/F Lytic culture was reserved primarily for detection of mycobacteria in patients with severely depressed CD4 counts. Implementation of this algorithm led to a sustained 3-fold reduction in Myco/F Lytic blood culture usage.
Retrospective analysis suggests substantial clinical equivalence of standard blood and Myco/F Lytic culture for detection of yeast. A multifaceted educational approach based on this data led to a sustained change in physician ordering practices and more cost-effective use of resources.
在临床实践中，专用真菌和分枝杆菌血培养瓶（如BACTEC Myco/F Lytic瓶）的最佳使用方法尚未明确界定。
在城市三级医疗医院环境中，比较Myco/F Lytic血培养瓶和标准血培养在临床实践中的性能，并实施Myco/F Lytic血培养瓶的最佳使用策略。
实验室记录的回顾性审查。
Myco/F Lytic血培养并未提高酵母菌的检出率。除光滑念珠菌外，它也没有缩短检测时间，在光滑念珠菌检测中，标准血培养的平均阳性时间为2.6±1.1天，而Myco/F Lytic血培养为1.8±0.8天。因此，制定了一种算法，其中Myco/F Lytic血培养主要用于检测CD4计数严重降低患者的分枝杆菌。该算法的实施使Myco/F Lytic血培养的使用量持续减少了3倍。
回顾性分析表明，标准血培养和Myco/F Lytic血培养在检测酵母菌方面具有相当的临床等效性。基于这些数据的多方面教育方法导致了医生医嘱习惯的持续改变，并更具成本效益地利用了资源。
