Hossain Belal, Islam Mohammad Shahidul, Rahman Atiqur, Marzan Mahfuza, Rafiqullah Iftekhar, Connor Nicholas E, Hasanuzzaman Mohammad, Islam Maksuda, Hamer Davidson H, Hibberd Patricia L, Saha Samir K
From the *Child Health Research Foundation, Dhaka, Bangladesh; †Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh; ‡Department of Global Health and Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts; and §Division of Global Health, Massachusetts General Hospital, Boston, Massachusetts.
Pediatr Infect Dis J. 2016 May;35(5 Suppl 1):S45-51. doi: 10.1097/INF.0000000000001106.
Interpretation of blood culture isolates is challenging due to a lack of standard methodologies for identifying contaminants. This problem becomes more complex when the specimens are from sick young infants, as a wide range of bacteria can cause illness among this group.
We used 43 key words to find articles published between 1970 and 2011 on blood culture isolates and possible contaminants in the PubMed database. Experts were also consulted to obtain other relevant articles. Selection of articles followed systematic methods considering opinions from more than 1 reviewer.
After reviewing the titles of 3869 articles extracted from the database, we found 307 relevant to our objective. Based on the abstracts, 42 articles were selected for the literature review. In addition, we included 7 more articles based on cross-references and expert advice. The most common methods for differentiating blood culture isolates were multiple blood cultures from the same subject, antibiograms and molecular testing. Streptococcus pneumoniae, Hemophilus influenzae, Neisseria meningitidis and group A and B streptococcus were always considered as pathogens, whereas Bacillus sp., Diphtheroids, Propionibacterium and Micrococcus were commonly regarded as contaminants. Coagulase-negative staphylococci were the most frequent isolates and usually reported as contaminants unless the patient had a specific condition, such as long-term hospitalization or use of invasive devices (catheters).
Inaccurate interpretation of blood culture may falsely guide treatment and also has long-term policy implications. The combination of clinical and microbiological knowledge, patient's clinical history and laboratory findings are essential for appropriate interpretation of blood culture.
由于缺乏鉴定污染物的标准方法，血培养分离物的解读具有挑战性。当标本来自患病的幼儿时，这个问题会变得更加复杂，因为多种细菌都可能导致该群体发病。
我们使用43个关键词在PubMed数据库中查找1970年至2011年间发表的关于血培养分离物及可能污染物的文章。我们还咨询了专家以获取其他相关文章。文章的选择遵循系统方法，参考了多位评审员的意见。
在审阅从数据库中提取的3869篇文章的标题后，我们发现307篇与我们的目标相关。基于摘要，我们选择了42篇文章进行文献综述。此外，根据交叉引用和专家建议，我们又纳入了7篇文章。区分血培养分离物的最常用方法是对同一受试者进行多次血培养、抗菌谱分析和分子检测。肺炎链球菌、流感嗜血杆菌、脑膜炎奈瑟菌以及A组和B组链球菌一直被视为病原体，而芽孢杆菌属、类白喉杆菌、丙酸杆菌和微球菌通常被视为污染物。凝固酶阴性葡萄球菌是最常见的分离菌，通常被报告为污染物，除非患者患有特定疾病，如长期住院或使用侵入性装置（导管）。
血培养的不准确解读可能会错误地指导治疗，并且还具有长期的政策影响。临床和微生物学知识、患者的临床病史以及实验室检查结果相结合，对于正确解读血培养至关重要。
