目的 了解血培养菌群分布及阳性报警时间在鉴别病原菌与污染菌中的意义.方法 对2009年7月至2011年12月间血培养分离的642株菌进行回顾性分析,观察菌群分布情况,对其中的148株可能污染菌与临床资料进行综合分析.结果 642株阳性分离菌中革兰阴性菌338株(52.6％),革兰阳性菌280株(43.6％),真菌24株(3.7％).＜18 h检出376株(58.6％),19 ～ 24 h检出120株(18.7％),25 ～48 h检出89株(13.9％),＞48 h检出57株(8.8％).148株可能污染菌与临床资料综合分析后确认其中111株为污染菌,污染率17.3％,均为革兰阳性菌,以凝固酶阴性葡萄球菌为主；33株为病原菌；4株不能确定.污染菌阳性报警时间均＞18h,其中19 ～ 24 h 14株,25 ～48 h 40株,＞48 h 57株.结论 本地区血培养菌群分布广,但污染率高.利用血培养阳性报警时间结合临床资料和其他辅助检查并按照一定的评估标准可以初步区分阳性分离菌是病原菌还是污染菌.%Objective To analyze the significance on the bacterial distribution in blood culture and the positive alarm time in differentiating the pathogens and contaminated bacteria. Methods The retrospective analysis of 642 isolates for blood culture from July 2009 to December 2011 was performed to observe the bacterial distribution, and 148 possible contaminated bacteria were comprehensively analyzed with the clinical data. Results Of the 642 positive isolates, 338(52. 6% ) were Gram-negative,280 (43.6%) were Gram-positive, and 24 (3. 7% ) were fungi. The 376 (58.6%) isolates were detected in < 18 h, 120 (18.7%) isolates were detected in 19-24 h, 89 (13.9%) isolates were detected in 25-48 h, and 57 (8.8%) isolates were detected in > 48 h. Totallylll of 148 isolates were identified to be contamination by reviewing the clinical data, and the contamination rate was 17. 3%. All the contaminated bacteria were Gram-positive, and coagulase negative Staphylococcus was major. The 33 isolates were pathogens, and 4 isolates were indeterminable. The counts of contamination durning 19-24 h, 25-48 h and >48 h were 14 isolates, 40 isolates and 57 isolates with positive alarm time > 18 h, respectively. Conclusions The bacterial distribution in blood culture is wide in this area, and the contamination rate is high. The pathogens and contaminated bacteria can initially be differentiated by the clinical data and other auxiliary examination combining with the positive alarm time according to certain evaluation standard.
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