李素幸 李成富 黄尚宝 张海业 李彤

【摘要】 目的：觀察直接药敏与常规药敏试验在临床血液细菌检验中的应用价值。方法：选择2015年1月-2017年12月至本院进行血液培养结果为阳性的患者546例进行临床研究。所有阳性患者均分别给予直接药敏检查和常规药敏检查，观察546例患者所检测到的革兰阴性菌和革兰阳性菌的菌种，以常规药敏检查结果作为标准，观察直接药敏试验菌种检测的符合率。比较两种方法的药敏结果与药敏检测所需时间。结果：对菌种的检测，与常规药敏试验相比，直接药敏试验检测总符合率为94.41%，革兰阴性杆菌符合率为95.22%，革兰阳性球菌符合率为92.13%。符合率最高的为大肠埃希菌和肺炎克雷伯菌，均为100%，最低的鲁氏不动杆菌为79.63%。两种药敏方法对革兰阳性菌与革兰阴性菌进行检测后，所得结果比较差异无统计学意义（P>0.05）。直接药敏试验用时为12～24 h，平均（15.52±2.54）h，常规药敏试验用时为48～72 h，平均（57.07±5.37）h，直接药敏试验检测用时明显低于常规药敏试验，差异有统计学意义（t=153.719，P=0.000）。结论：直接药敏与常规药敏试验在临床血液细菌检验中均具有重要的临床应用价值，常规药敏试验准确性高，但用时长，直接药敏试验准确性略低于常规药敏试验，但是明显缩短了检测用时。

【关键词】 直接药敏； 常规药敏； 血液细菌检测

【Abstract】 Objective：To observe the application value of direct drug sensitivity and conventional drug sensitivity test in clinical blood bacterial test.Method：A clinical study was conducted in 546 patients with positive Blood culture from January 2015 to December 2017 from to our hospital.All patients were given direct drug sensitivity test and routine drug sensitivity test respectively.The Gram-negative and Gram-positive bacteria strains detected in 546 patients were observed.The coincidence rate of the direct drug susceptibility test was observed with the results of routine drug sensitivity test as the standard.The drug sensitivity results of the two methods and the time needed for drug sensitivity test were compared.Result：For the detection of bacteria，compared with the routine drug sensitivity test，the overall coincidence rate of direct drug sensitivity test was 94.41%，the coincidence rate of Gram-negative bacilli was 95.22%，and the coincidence rate of Gram-positive cocci was 92.13%.The highest coincidence rate of Escherichia coli and klebsiella pneumoniae were 100%，the lowest was Acinetobacter lwoffi（79.63%）.Two kinds of drug sensitivity methods were used to detect Gram-positive bacteria and Gram-negative bacteria， and the results were not statistically different（P>0.05）.Direct drug sensitivity test for 12-24 h，the average time （15.52±2.54）h，conventional drug susceptibility testing time was 48-72 h，the average time was （57.07±5.37）h，direct drug sensitivity test with significantly lower than the conventional drug susceptibility test，and had a statistically significant difference（t=153.719，P=0.000）.Conclusion：The drug sensitivity and conventional drug susceptibility testing have an important clinical value in the clinical examination of bacteria in blood，routine drug susceptibility test with high accuracy，but in long time，the accuracy of direct drug sensitivity test is slightly lower than that of conventional drug susceptibility testing，but significantly shorten the detection time.

【Key words】 Direct drug sensitivity； Conventional drug sensitivity； Blood bacterial detection

First-authors address：Xinyi Peoples Hospital，Xinyi 525300，China

doi：10.3969/j.issn.1674-4985.2018.18.038

细菌感染是临床常见的疾病，如果感染不能得到及时有效的控制，细菌进入血液，可能会引起菌血症、败血症等严重疾病，甚至导致死亡，因此对于细菌感染的患者，寻找有效的抗生素就成为治疗的关键[1]。临……