Chren M M, Lazarus H M, Salata R A, Landefeld C S
Department of Dermatology, Skin Diseases Research Center, University Hospitals of Cleveland, Ohio, USA.
Arch Dermatol. 1995 May;131(5):552-5.
Microbiological cultures of skin biopsy tissue are often recommended in immunocompromised patients with cancer and rashes, but in a previous study, they were usually sterile or grew clinically insignificant organisms. To examine the use and bacteriological results of these cultures more comprehensively, we reviewed records from all immunocompromised adults with cancer and acute rash on which skin biopsy was performed during 39 months on a bone marrow transplantation/acute leukemia unit of a university hospital (108 episodes of rash in 80 patients).
Of the 158 cultures that were performed, one (1%; 95% confidence interval [CI], 0% to 4%) was a true positive; 11 (7%; 95% CI, 3% to 13%) were false positive; 143 (91%; 95% CI, 87% to 95%) were true negative; and three (2%; 95% CI, 1% to 6%) were false negative. Thus, the sensitivity of culture was 0.25, and the specificity was 0.93. Coagulase-negative Staphylococcus was the single pathogenic organism that grew, yet was judged to be a contaminant in three episodes. Among the 95 rashes in which fewer than four types of culture were performed, viral culture may have been helpful in one case (1%; 95% CI, 0% to 6%).
Cultures of skin tissue from immunocompromised cancer patients with rashes were often unable to diagnose infection or the absence of infection. Clinical judgement was crucial to the interpretation of culture results.
对于患有癌症且出现皮疹的免疫功能低下患者，通常建议对皮肤活检组织进行微生物培养，但在之前的一项研究中，这些培养物通常是无菌的，或者培养出的是临床上无显著意义的微生物。为了更全面地研究这些培养的用途和细菌学结果，我们回顾了一所大学医院骨髓移植/急性白血病科室在39个月期间对所有患有癌症且出现急性皮疹的免疫功能低下成年患者进行皮肤活检的记录（80例患者中有108次皮疹发作）。
在进行的158次培养中，1次（1%；95%置信区间[CI]，0%至4%）为真阳性；11次（7%；95%CI，3%至13%）为假阳性；143次（91%；95%CI，87%至95%）为真阴性；3次（2%；95%CI，1%至6%）为假阴性。因此，培养的敏感性为0.25，特异性为0.93。凝固酶阴性葡萄球菌是培养出的唯一病原菌，但在3次发作中被判定为污染物。在进行少于4种培养类型的95次皮疹中，病毒培养可能在1例中有所帮助（1%；95%CI，0%至6%）。
对患有皮疹的免疫功能低下癌症患者的皮肤组织进行培养，往往无法诊断感染或未感染情况。临床判断对于培养结果的解读至关重要。
