Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA.
Future Microbiol. 2014;9(4):543-59. doi: 10.2217/fmb.14.8.
Bacteremia and fungemia account for a substantial proportion of all cases of severe sepsis. Antibiotic resistance is a contributing factor in many hospital-acquired infection deaths. Traditional phenotypic methods for the identification of bacteria and yeasts from positive blood cultures and determining antimicrobial susceptibility require 48-72 h, delaying optimal therapy and negatively impacting patient outcomes. Molecular methods, including nonamplified DNA probe panels and peptide nucleic acid probes, and nucleic acid amplification methods such as PCR, proteomic methods (matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry) and direct biochemical tests provide more rapid identification of bacteria and fungi, and in some cases antimicrobial resistance markers, from positive blood cultures, as well as directly from whole blood. These methods vary in the breadth of organisms that they detect, and equally important, their ease of use. This article examines the principles, performance and practicality of the various rapid, nonculture techniques for the detection of bacteremia and fungemia.
菌血症和真菌血症在所有严重脓毒症病例中占很大比例。抗生素耐药性是许多医院获得性感染死亡的一个因素。从阳性血培养物中鉴定细菌和酵母菌以及确定抗菌药物敏感性的传统表型方法需要 48-72 小时，这会延迟最佳治疗并对患者预后产生负面影响。分子方法，包括非扩增 DNA 探针组和肽核酸探针，以及核酸扩增方法，如 PCR、蛋白质组学方法（基质辅助激光解吸/电离-飞行时间质谱）和直接生化检测，可更快速地从阳性血培养物中鉴定细菌和真菌，在某些情况下还可鉴定出抗菌药物耐药性标志物，甚至可直接从全血中鉴定。这些方法在检测的生物体的范围上有所不同，同样重要的是，它们的易用性也有所不同。本文探讨了用于检测菌血症和真菌血症的各种快速、非培养技术的原理、性能和实用性。
