Catchpole C R, Macrae F, Brown J D, Palmer M, Healing D E, Richards N T, Elliott T S
Department of Clinical Microbiology, Queen Elizabeth Hospital, Birmingham, United Kingdom.
J Clin Pathol. 1997 Mar;50(3):241-4. doi: 10.1136/jcp.50.3.241.
(1) To compare the recovery of organisms from continuous ambulatory peritoneal dialysis (CAPD) effluent fluid obtained from patients with clinical evidence of peritonitis, with an automated system (AS) and the Septichek blood culture system; (2) to evaluate the times to detection of organisms with the two systems; (3) to identify anaerobes from CAPD samples by extended anaerobic culture and gas-liquid chromatography (GLC).
168 CAPD effluent fluid samples were studied, representing 157 episodes of peritonitis in 97 patients. CAPD samples were inoculated into two AS bottles-one anaerobic, one aerobic-and a Septichek bottle; samples were also examined for cell count, Gram stain, and direct culture. Culture bottles were then subcultured onto various media, and any organisms isolated were identified. After routine culture, GLC was performed on culture fluid in the anaerobic AS and Septichek bottles. When volatile fatty acids were detected, the broths were cultured anaerobically on specialised medium for a further five days.
147 organisms were isolated from the 168 samples: 96 (57%) yielded growth of significant organisms by direct culture, as compared to 129 (76.8%) by both AS and Septichek. There was no significant difference in isolation rates between AS and Septichek, but time to detection was more rapid with the AS system (p < 0.002). GLC showed volatile fatty acid in 15 specimens; of these, 14 subsequently grew anaerobic organisms.
AS was comparable to Septichek for numbers of isolations. Speed to detection was faster with the AS, which may be an advantage in management of patients with CAPD peritonitis. GLC showed anaerobes in several cases which would not have been detected without prolonged anaerobic culture; thus anaerobic cultures are recommended for patients who are unresponsive to antimicrobials or who have evidence of bowel perforation.
（1）比较利用自动系统（AS）和Septichek血培养系统，从有腹膜炎临床证据的持续性非卧床腹膜透析（CAPD）患者的流出液中分离微生物的情况；（2）评估两种系统检测到微生物的时间；（3）通过延长厌氧培养和气-液色谱法（GLC）从CAPD样本中鉴定厌氧菌。
研究了168份CAPD流出液样本，代表97例患者的157次腹膜炎发作。将CAPD样本接种到两个AS瓶中——一个厌氧瓶，一个需氧瓶——以及一个Septichek瓶中；样本还进行了细胞计数、革兰氏染色和直接培养。然后将培养瓶接种到各种培养基上，并对分离出的任何微生物进行鉴定。常规培养后，对厌氧AS瓶和Septichek瓶中的培养液进行GLC分析。当检测到挥发性脂肪酸时，将肉汤在专用培养基上厌氧培养5天。
从168份样本中分离出147种微生物：96种（57%）通过直接培养产生有意义的微生物生长，而AS和Septichek两者的培养结果为129种（76.8%）。AS和Septichek之间的分离率没有显著差异，但AS系统的检测时间更快（p<0.002）。GLC显示有15份标本中有挥发性脂肪酸；其中14份随后培养出厌氧菌。
AS在分离数量上与Septichek相当。AS的检测速度更快，这可能是CAPD腹膜炎患者管理中的一个优势。GLC在几例病例中显示出厌氧菌，若不进行延长厌氧培养则无法检测到；因此，对于对抗菌药物无反应或有肠穿孔证据的患者，建议进行厌氧培养。
