Banerjee Ritu, Özenci Volkan, Patel Robin
Department of Pediatric Infections Diseases, Vanderbilt University, Nashville, Tennessee.
Division of Clinical Microbiology, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
Clin Infect Dis. 2016 Nov 15;63(10):1332-1339. doi: 10.1093/cid/ciw573. Epub 2016 Aug 23.
Many strategies and technologies are available to improve blood culture (BC)-based diagnostics. The ideal approach to BCs varies between healthcare institutions. Institutions need to examine clinical needs and practices in order to optimize BC-based diagnostics for their site. Before laboratories consider offering rapid matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-ToF MS) or expensive rapid panel-based molecular BC diagnostics, they should optimize preanalytical, analytical, and postanalytical processes and procedures surrounding BC systems. Several factors need to be considered, including local resistance rates, antibiotic prescribing patterns, patient- and provider-types, laboratory staffing, and personnel available to liaise with clinicians to optimize antibiotic use. While there is much excitement surrounding new high-technology diagnostics, cost-neutral benefits can be realized by optimizing existing strategies and using available tools in creative ways. Rapid BC diagnostics should be implemented in a manner that optimizes impact. Strategies to optimize these BC diagnostics in individual laboratories are presented here.
有许多策略和技术可用于改进基于血培养（BC）的诊断。基于血培养的理想方法在不同医疗机构之间存在差异。各机构需要审视临床需求和实践，以便为其所在机构优化基于血培养的诊断。在实验室考虑提供快速基质辅助激光解吸/电离飞行时间质谱（MALDI-ToF MS）或昂贵的基于快速检测板的分子血培养诊断之前，应优化围绕血培养系统的分析前、分析中和分析后流程及程序。需要考虑几个因素，包括当地的耐药率、抗生素处方模式、患者和医疗服务提供者类型、实验室人员配备以及可与临床医生联系以优化抗生素使用的人员。虽然新型高科技诊断备受关注，但通过优化现有策略并创造性地使用现有工具，可以实现成本不变的效益。快速血培养诊断应以优化影响的方式实施。本文介绍了在各个实验室中优化这些血培养诊断的策略。
