疑似急性眼内炎中鉴定致病细菌微生物方法的比较：传统培养、血培养和聚合酶链反应。
Comparison of methods for identifying causative bacterial microorganisms in presumed acute endophthalmitis: conventional culture, blood culture, and PCR.
作者信息
Pongsachareonnont Pear, Honglertnapakul Worawalun, Chatsuwan Tanittha
机构信息
Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University; and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
出版信息
BMC Infect Dis. 2017 Feb 21;17(1):165. doi: 10.1186/s12879-017-2264-5.
BACKGROUND
Identification of bacterial pathogens in endophthalmitis is important to inform antibiotic selection and treatment decisions. Hemoculture bottles and polymerase chain reaction (PCR) analysis have been proposed to offer good detection sensitivity. This study compared the sensitivity and accuracy of a blood culture system, a PCR approach, and conventional culture methods for identification of causative bacteria in cases of acute endophthalmitis.
METHODS
Twenty-nine patients with a diagnosis of presumed acute bacterial endophthalmitis who underwent vitreous specimen collection at King Chulalongkorn Memorial Hospital were enrolled in this study. Forty-one specimens were collected. Each specimen was divided into three parts, and each part was analyzed using one of three microbial identification techniques: conventional plate culture, blood culture, and polymerase chain reaction and sequencing. The results of the three methods were then compared.
RESULTS
Bacteria were identified in 15 of the 41 specimens (36.5%). Five (12.2%) specimens were positive by conventional culture methods, 11 (26.8%) were positive by hemoculture, and 11 (26.8%) were positive by PCR. Cohen's kappa analysis revealed p-values for conventional methods vs. hemoculture, conventional methods vs. PCR, and hemoculture vs. PCR of 0.057, 0.33, and 0.009, respectively. Higher detection rates of Enterococcus faecalis were observed for hemoculture and PCR than for conventional methods.
CONCLUSIONS
Blood culture bottles and PCR detection may facilitate bacterial identification in cases of presumed acute endophthalmitis. These techniques should be used in addition to conventional plate culture methods because they provide a greater degree of sensitivity than conventional plate culture alone for the detection of specific microorganisms such as E. faecalis.
TRIAL REGISTRATION
Thai Clinical Trial Register No. TCTR20110000024 .
背景
确定眼内炎中的细菌病原体对于指导抗生素选择和治疗决策至关重要。血培养瓶和聚合酶链反应（PCR）分析被认为具有良好的检测敏感性。本研究比较了血培养系统、PCR方法和传统培养方法在急性眼内炎病例中鉴定致病细菌的敏感性和准确性。
方法
本研究纳入了29例在朱拉隆功国王纪念医院被诊断为疑似急性细菌性眼内炎并接受玻璃体标本采集的患者。共采集了41份标本。每份标本分为三部分，每部分分别采用三种微生物鉴定技术之一进行分析：传统平板培养、血培养以及PCR和测序。然后比较三种方法的结果。
结果
41份标本中有15份（36.5%）鉴定出细菌。传统培养方法检测出5份（12.2%）标本呈阳性，血培养检测出11份（26.8%）呈阳性，PCR检测出11份（26.8%）呈阳性。Cohen's kappa分析显示，传统方法与血培养、传统方法与PCR、血培养与PCR的p值分别为0.057、0.33和0.009。血培养和PCR检测粪肠球菌的阳性率高于传统方法。
结论
血培养瓶和PCR检测可能有助于疑似急性眼内炎病例中细菌的鉴定。除传统平板培养方法外，还应使用这些技术，因为它们在检测特定微生物如粪肠球菌时比单独使用传统平板培养具有更高的敏感性。
试验注册
泰国临床试验注册号TCTR20110000024 。
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