Microbiology Technical Services, LLC, Dunwoody, Georgia.
Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
Clin Infect Dis. 2018 Aug 31;67(6):e1-e94. doi: 10.1093/cid/ciy381.
The critical nature of the microbiology laboratory in infectious disease diagnosis calls for a close, positive working relationship between the physician/advanced practice provider and the microbiologists who provide enormous value to the healthcare team. This document, developed by experts in laboratory and adult and pediatric clinical medicine, provides information on which tests are valuable and in which contexts, and on tests that add little or no value for diagnostic decisions. This document presents a system-based approach rather than specimen-based approach, and includes bloodstream and cardiovascular system infections, central nervous system infections, ocular infections, soft tissue infections of the head and neck, upper and lower respiratory infections, infections of the gastrointestinal tract, intra-abdominal infections, bone and joint infections, urinary tract infections, genital infections, and other skin and soft tissue infections; or into etiologic agent groups, including arthropod-borne infections, viral syndromes, and blood and tissue parasite infections. Each section contains introductory concepts, a summary of key points, and detailed tables that list suspected agents; the most reliable tests to order; the samples (and volumes) to collect in order of preference; specimen transport devices, procedures, times, and temperatures; and detailed notes on specific issues regarding the test methods, such as when tests are likely to require a specialized laboratory or have prolonged turnaround times. In addition, the pediatric needs of specimen management are also emphasized. There is intentional redundancy among the tables and sections, as many agents and assay choices overlap. The document is intended to serve as a guidance for physicians in choosing tests that will aid them to quickly and accurately diagnose infectious diseases in their patients.
微生物学实验室在传染病诊断中的关键作用要求医生/高级执业医师与微生物学家之间建立密切、积极的工作关系，后者为医疗团队提供巨大的价值。这份由实验室和成人及儿科临床医学专家制定的文件提供了有关有价值和有意义的检测以及那些对诊断决策几乎没有或没有增加价值的检测的信息。本文采用基于系统的方法而不是基于标本的方法，涵盖了血流感染和心血管系统感染、中枢神经系统感染、眼部感染、头颈部软组织感染、上呼吸道和下呼吸道感染、胃肠道感染、腹内感染、骨与关节感染、尿路感染、生殖器感染和其他皮肤和软组织感染；或按病原体分组，包括节肢动物传播感染、病毒性综合征以及血液和组织寄生虫感染。每个部分都包含介绍性概念、要点总结以及详细的表格，其中列出了可疑病原体、最应进行的检测、按优先顺序采集的样本（和体积）、标本运输设备、程序、时间和温度，以及有关检测方法的具体问题的详细说明，例如哪些情况下可能需要特殊实验室或检测时间较长。此外，还强调了儿科标本管理的需求。表格和部分之间存在有意的重复，因为许多病原体和检测选择存在重叠。本文件旨在为医生提供指导，帮助他们选择有助于快速准确诊断患者传染病的检测。
