a Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia , Università di Pisa , Pisa , Italy.
b U.O. Microbiologia Universitaria Azienda Ospedaliero-Universitaria Pisana , Pisa , Italy.
Crit Rev Microbiol. 2018 May;44(3):351-370. doi: 10.1080/1040841X.2017.1407745. Epub 2017 Nov 29.
Rapid identification (ID) and antimicrobial susceptibility testing (AST) of the causative agent(s) of bloodstream infections (BSIs) are essential for the prompt administration of an effective antimicrobial therapy, which can result in clinical and financial benefits. Immediately after blood sampling, empirical antimicrobial therapy, chosen on clinical and epidemiological data, is administered. When ID and AST results are available, the clinician decides whether to continue or streamline the antimicrobial therapy, based on the results of the in vitro antimicrobial susceptibility profile of the pathogen. The aim of the present study is to review and discuss the experimental data, advantages, and drawbacks of recently developed technological advances of culture-based and molecular methods for the diagnosis of BSI (including mass spectrometry, magnetic resonance, PCR-based methods, direct inoculation methods, and peptide nucleic acid fluorescence in situ hybridization), the understanding of which could provide new perspectives to improve and fasten the diagnosis and treatment of septic patients. Although blood culture remains the gold standard to diagnose BSIs, newly developed methods can significantly shorten the turnaround time of reliable microbial ID and AST, thus substantially improving the diagnostic yield.
快速鉴定（ID）和抗菌药物敏感性测试（AST）血流感染（BSI）的病原体对于及时给予有效抗菌治疗至关重要，这可以带来临床和经济效益。在采血后立即根据临床和流行病学数据给予经验性抗菌治疗。当 ID 和 AST 结果可用时，临床医生根据病原体的体外抗菌药敏谱结果决定是否继续或简化抗菌治疗。本研究旨在综述和讨论基于培养和分子方法的最近技术进展，包括质谱、磁共振、基于 PCR 的方法、直接接种方法和肽核酸荧光原位杂交）用于诊断 BSI 的实验数据、优点和缺点，对其的了解可以为改善和加快脓毒症患者的诊断和治疗提供新的视角。虽然血培养仍然是诊断 BSI 的金标准，但新开发的方法可以显著缩短可靠微生物 ID 和 AST 的周转时间，从而大大提高诊断的阳性率。
