臨床常見病原體檢測工作

1、1臨床常見病原體檢測工作 Examination of clinical common pathogens2目的Objective確定感染的發(fā)生和性質(zhì)，及早明確診斷；Determine the occuring and nature of infection, and make diagnosis early;盡早選擇適當(dāng)?shù)闹委煼桨?；Select the appropriate treatment as soon as possible;采取有效的預(yù)防措施，防止感染可能廣泛傳播所造成的危害。Take effective prevention measures to prevent infect

2、ion to cause widespread damage. 3基本程序Basic Procedures正確采集和運(yùn)送標(biāo)本；Correct collection and transportation of specimens初步診斷：直接鏡檢，免疫學(xué)和分子生物學(xué)檢測；Initial diagnosis: direct microscopy, immunology and molecular biology examination;確定診斷：病原體的分離、鑒定及藥敏實(shí)驗(yàn)，報(bào)告結(jié)果；Determined diagnosis: pathogen isolation, identification

3、and sensitivity test, reporting results;合理用藥Appropriate drug use4第一節(jié)Section One標(biāo)本的采集運(yùn)送、實(shí)驗(yàn)室評價(jià)和檢查方法Transportation and collection of specimen, laboratory evaluation and examination methods5一、標(biāo)本采集和運(yùn)送One. Collection and transportation of Specimen 6基本原則Basic principles根據(jù)病史與臨床表現(xiàn)確定標(biāo)本采集的時間、部位、種類和數(shù)量，盡量采集病變明顯部

4、位標(biāo)本；According to history and clinical manifestations to determine the collection time, location, type and quantity of specimens, collect specimens at significant parts of lesions; 無菌操作，防止污染；Use aseptic technique to prevent contamination; 采取適宜的方式進(jìn)行儲存，盡快送檢；Appropriate way to store, as soon as possible

5、 for examination;要視所有標(biāo)本為傳染品，高度危險(xiǎn)性的標(biāo)本要有明顯標(biāo)識，急癥或危重患者標(biāo)本要特別注明。To view all the specimens for infectious, high risk specimens should be clearly marked, acute or critically ill patient specimens should be specified.7（一）血液(One) Blood適應(yīng)癥：疑為菌血癥、敗血癥或膿毒血癥的病人；Indications: suspected bacteremia, sepsis or sepsis p

6、atients; 一般在抗生素使用前，于發(fā)熱初期或高峰期采血；已用過抗菌藥物治療者，在下次用藥前采集；In general, prior to use of antibiotics, in the early or peak heat, to collect blood; if antibiotic treatment has been used, collect blood before the next administration;以無菌法由肘靜脈穿刺，一般成人采血量每次1020ml，嬰兒和兒童1-5ml ，在床邊接種；Puncture cubital vein by a sterile

7、 method, in general, 10 20ml blood per time for adult, 1-5ml for infants and children, and inoculate at the bedside;注明抗生素使用情況，選擇合適類型的培養(yǎng)瓶；Indicate the use of antibiotics, select the appropriate type of culture flask;24小時內(nèi)在不同部位采血3次可提高陽性率。Collecting blood at different parts 3 times within 24 hours can

8、increase the positive rate.8血液標(biāo)本的采集方法Collection method of blood samples9（二）尿液(Two) Urine無菌采集中段尿；Sterile collection of mid-portion urine;如考慮厭氧菌感染，采取膀胱穿刺法采集標(biāo)本，無菌厭氧小瓶運(yùn)送；If consideration of anaerobic infections, apply bladder puncture to collect specimens, transport them with sterile anaerobic vial;排尿困難

9、者考慮導(dǎo)尿采集標(biāo)本。Apply catheterization to collect specimens for dysuria patients.10（三）糞便(Three) Stool挑取膿、血或粘液部分于清潔容器中送檢；Pick pus, blood or mucus from stoll into clean containers for examination;排便困難者或嬰兒采用直腸拭子采集，置于有保存液的試管內(nèi)送檢；Apply rectal swab for infants or difficult defecation, place it with preservation s

10、olution in the test tube for examination; 懷疑霍亂弧菌感染引起的腹瀉，將標(biāo)本置于堿性蛋白胨水或卡-布（Cary-Blair）運(yùn)送培養(yǎng)液送檢；Suspected infections caused by Vibrio cholerae, the specimens were placed in alkaline peptone water or card - cloth (Cary-Blair) transport medium for examination;傳染性腹瀉應(yīng)連續(xù)送檢3次。Continuous examination 3 times for

11、 infectious diarrhea.11（四）呼吸道標(biāo)本(Four) Respiratory specimens類型：鼻咽拭子，痰和經(jīng)氣管采集的標(biāo)本；Types: nasopharyngeal swab, sputum, and specimens collected through tracheal上呼吸道存在正常菌群，在采集標(biāo)本與結(jié)果分析時應(yīng)予考慮。There is normal flora in upper respiratory tract, the specimens collection and results analysis should be considered.12

12、（五）腦脊液與其他無菌體液(Five) Cerebrospinal fluid and other sterile body fluids腦脊液應(yīng)立即保溫送檢或床邊接種；CSF should be transported immediately with insulation or cultured bedside；胸腔積液、腹腔積液和心包積液等應(yīng)采集較大量標(biāo)本送檢，離心后再接種培養(yǎng)。Pleural effusion, ascites and pericardial effusion with a large volume should be collected, centrifugated

13、and then cultured.13（六）眼、耳部標(biāo)本(Six) Eye, ear specimens拭子采樣Swab samples14（七）泌尿生殖道標(biāo)本(Seven) Urogenital specimens男性：無菌采集尿道口分泌物或前列腺液；Male: urethra or prostatic fluid secretions with sterile collection; 女性：無菌采集陰道或?qū)m頸分泌物。Female: vaginal or cervical secretions collected aseptically.15（八）創(chuàng)傷、組織和膿腫標(biāo)本(Eight) Tra

14、uma, organization, and abscess specimens對損傷范圍較大的創(chuàng)傷，從不同部位采集多份標(biāo)本；On a wider range of trauma injuries, specimens collected from many different parts; 采集部位應(yīng)首先清除污物、消毒皮膚；Firstly remove dirt, disinfect the skin around collection site;標(biāo)本較少則需加入無菌生理鹽水以防干燥；Fewer samples must be added to sterile saline to preve

15、nt drying;開放性膿腫及膿性分泌物：用無菌棉纖采取膿液或病灶深部分泌物；Open abscess and purulent secretions: collect deep discharge pus or lesions with sterile cotton fibers; 封閉性膿腫用注射器抽??；Collect specimen in closed abscess with a syringe;懷疑厭氧菌感染，應(yīng)隔絕空氣采集。Suspected anaerobic infections, collection should be isolated from air.16（九）血清

16、(Nine) Serum用于檢測特異性抗體；For the detection of specific antibodies;血液自然凝固后吸取血清，滅活補(bǔ)體。Draw serum after natural coagulation of blood, then inactivate complement.17二、標(biāo)本的實(shí)驗(yàn)室質(zhì)量評估標(biāo)準(zhǔn)Two. Standard of laboratory quality assessment of specimens18檢驗(yàn)申請單的基本內(nèi)容The basic content of an application for examinationThe pati

17、ent,s name and hospital number.Age and sex.Collection date and time.Suspected diagnosis.Exact nature and source of the specimen.Immunization history and antimicrobial therapy.Objective.Signed by physician.19標(biāo)本接收和拒收準(zhǔn)則Reception and rejection criteria for specimens1 The information on the label does no

18、t exist or not match the information on the requisition;2 Delay in delivery of the specimens;3 The specimen is leaking; 4 The specimen has been transported at the improper temperature or in improper medium.205 Contaminated samples;6 The quantity of specimen is insufficient for testing;7 Duplicate su

19、bmission of specimens (except blood cultures);8 The transportation of specimens of severe infectious diseases should comply with the relevant rules.21三、檢查方法Three. Examination methods 22（一）直接顯微鏡檢查(One) Direct microscopic examination不染色標(biāo)本檢查法：用于觀察病原體的生長、形態(tài)與運(yùn)動等特性；Not stained specimen test method: to obs

20、erve the growth, shape and motion characteristics of pathogens;評價(jià)：部分病原體可借此初步診斷。Evaluation: for some pathogens, the initial diagnosis can be taken.23染色標(biāo)本檢查法：觀察細(xì)菌的形態(tài)、染色性或觀察宿主細(xì)胞內(nèi)包涵體的特征；Stained specimen test method: to observe bacterial morphology, staining or observe the characteristics of the inclusio

21、n bodies in host cell; 評價(jià)：為臨床初步診斷提供依據(jù)。Evaluation: available basis for the preliminary clinical diagnosis.24革蘭氏（染色）陽性球菌Gram (staining)-positive cocci革蘭氏（染色）陰性桿菌Gram (staining)-negative bacilli25抗酸染色陽性桿菌（抗酸桿菌）Acid-fast stain-positive bacilli (Acid-fast bacilli)26（二）病原體特異性抗原檢查(Two) Pathogen-specific an

22、tigen test免疫熒光技術(shù)Immunofluorescence technique酶聯(lián)免疫技術(shù)ELISA化學(xué)發(fā)光技術(shù)Chemiluminescence technology乳膠凝集試驗(yàn)Latex agglutination test對流免疫電泳Counter immuno electrophoresis蛋白質(zhì)芯片Protein chips27病原體特異性抗原檢測結(jié)果評價(jià)Evaluation of pathogen-specific antigen test results如果能排除交叉抗原的影響，病原體抗原檢測可明確感染的病原體。If the impact of cross-antige

23、n can be excluded, pathogen antigen test could clear the infection of pathogens.28（三）病原體核酸檢查(Three) Pathogen nucleic acid test聚合酶鏈?zhǔn)椒磻?yīng)：擴(kuò)增病原體微生物特異的DNA或 RNA片段；Polymerase chain reaction (PCR): amplify the specific fragments of DNA or RNA of microbial pathogens;實(shí)時熒光定量PCR技術(shù)；Real-time PCR; 核酸探針雜交技術(shù)：通過已知序列的

24、探針與標(biāo)本中的病原體的核苷酸雜交，用以了解病原體的有無；Nucleic acid probe hybridization: hybridization between the known sequence of the probe and the nucleotide of pathogens in the samples, to explore whether pathogens exist;基因芯片技術(shù)。Gene chip or DNA microarray.29病原體核酸檢查結(jié)果評價(jià)Evaluation of pathogen DNA test results是檢測病原體微生物最靈敏的方

25、法，但具有一定的假陽性與假陰性；is the most sensitive detection method for microbial pathogens, but has some false positive and false negative;陽性只表明存在某種病原體的核酸，是否正被感染應(yīng)結(jié)合臨床具體分析。is the only show that the existence of a positive pathogen nucleic acid, whether being infected should be combined with clinical specific ana

26、lysis.30（四）病原體的分離培養(yǎng)與鑒定(Four) Isolation, culture and identification of pathogens1 細(xì)菌感染性疾病病原體的分離培養(yǎng)1 Isolation and culture the pathogens of bacterial infections 明確感染病原體；Clear the pathogens;為臨床提供體外抗微生物藥物敏感試驗(yàn)結(jié)果。Provide vitro test results of anti-microbial drug sensitivity for clinical.312 不能人工培養(yǎng)的病原體感染性疾病

27、2 Not cultivated pathogens of infectious disease將標(biāo)本接種易感動物、雞胚或行細(xì)胞培養(yǎng)。Specimens were inoculated into susceptible animals, eggs or cell lines.32（五）血清學(xué)實(shí)驗(yàn)(Five) Serological test特異性 IgM可作為感染性疾病的早期診斷指標(biāo)，且可區(qū)分原發(fā)與復(fù)發(fā)感染；Specific IgM can be indicator of early diagnosis for infectious diseases and can distinguish b

28、etween primary and recurrent infections;特異性 IgG，尤其雙份血清的滴度呈4倍或4倍以上升高，考慮現(xiàn)癥感染。For IgG, the titer of double serum higher 4 times or more than 4 times, current pathogen infection should be considered.33第二節(jié) 病原體耐藥性檢測Section two Detection of pathogen drug resistance 34抗生素壓力Antibiotic pressure35一、耐藥性及其發(fā)生機(jī)制On

29、e. Drug resistance and its mechanism 36（一）耐藥病原體(One) Drug resistant pathogens革蘭氏陰性桿菌： -內(nèi)酰胺酶、超廣譜 -內(nèi)酰胺酶(ESBL)、類 -內(nèi)酰胺酶、多重耐藥等；Gram-negative bacillus: - lactamase, extended spectrum - lactamase (ESBL), type - lactamases, multidrug resistance, etc.;革蘭氏陽性球菌：耐甲氧西林葡萄球菌(MRS)、耐青霉素肺炎鏈球菌(PRSP)、耐萬古霉素腸球菌(VRE)、高耐氨基

30、糖苷類抗生素腸球菌。Gram-positive coccus: methicillin-resistant Staphylococcus (MRS), penicillin-resistant Streptococcus pneumoniae (PRSP), vancomycin-resistant enterococcus (VRE), enterococcus with high resistance to aminoglycoside antibiotics.37（二）耐藥機(jī)制(Two) Drug resistance mechanism1 細(xì)菌水平和垂直傳播耐藥基因的整合子系統(tǒng)；1 H

31、orizontal and vertical transmission of bacterial drug resistance genes through integrons;2 產(chǎn)生滅活抗生素的水解酶和鈍化酶, 如ESBLs， AmpC -內(nèi)酰胺酶，碳青霉烯酶，氨基糖苷類鈍化酶；2 proteolytic enzyme and inactive enzyme produced for inactivation of antibiotics, such as ESBLs, AmpC lactamase, carbapenemase, aminoglycoside inactive enzym

32、e; 383 細(xì)菌抗生素作用靶位的改變；3 Changes in the bacterial antibiotics target；4 細(xì)菌膜外排泵出系統(tǒng)；4 Bacterial membrane efflux pump system；5 細(xì)菌生物膜的形成。5 Bacterial biofilm (BF) formation.39二、檢查項(xiàng)目、結(jié)果和臨床應(yīng)用examination projects, results and clinical application40（一）藥物敏感試驗(yàn)Drug sensitivity test 抗微生物藥物敏感試驗(yàn)(antimicrobial suscepti

33、bility test, AST)對敏感性不能預(yù)測的臨床分離菌株進(jìn)行藥敏試驗(yàn)，以指導(dǎo)臨床選擇治療藥物。 AST can not be predicted on the sensitivity of clinical isolates for susceptibility testing to guide clinical treatment of drug41目的Objective臨床分離菌株，如不能對抗生素敏感性進(jìn)行預(yù)測，必須常規(guī)進(jìn)行藥敏試驗(yàn)。Clinical isolates, if they can not predict the sensitivity to antibiotics s

34、hould be routine susceptibility testing臨床治療效果差而考慮調(diào)整抗菌藥物時。Poor clinical treatment to consider adjusting the antimicrobial drugs.了解細(xì)菌耐藥的流行病學(xué)情況。Understand the epidemiology of bacterial resistance.評價(jià)新抗菌藥物的抗菌譜和抗菌活性等。Evaluation of new antibiotics and antibacterial activity of antibacterial spectrum.42方法Me

35、thods1 K-B紙片瓊脂擴(kuò)散法（Kirby-Bauer disc agar diffusion method）43參照NCCLS標(biāo)準(zhǔn)NCCLS standard reference敏感（susceptible，S）：表示測試菌能被測定藥物常規(guī)劑量給藥后在體內(nèi)達(dá)到的血藥濃度所抑制或殺滅。Bacteria can be determined that the test drugs in the body after administration of conventional doses to achieve plasma concentrations inhibit or kill.耐藥（r

36、esistant，R）：表示測試菌不能被測定藥物常規(guī)劑量給藥后在體內(nèi)達(dá)到的血藥濃度所抑制或殺滅，治療無效。Test bacteria that can not be measured after administration of conventional dose of drug in the body to the plasma concentrations inhibit or kill, the treatment ineffective.中介 (intermediate，I) : 該范圍作為敏感與耐藥之間的緩沖區(qū)，避免由于微小技術(shù)誤差影響實(shí)驗(yàn)結(jié)果。The range as a buf

37、fer between sensitive and resistant to avoid the impact of the small technical error results.442 稀釋法（Dilution test） 最低抑菌濃度（MIC）：能夠抑制檢測菌肉眼可見生長的最低藥物濃度稱為測定藥物對檢測菌的最低抑菌濃度。 Minimum inhibitory concentration (MIC): Detection of bacteria able to inhibit visible growth of the minimum drug concentration determ

38、ination of drugs on the detection of bacteria known as the minimum inhibitory concentration.3 E試驗(yàn)法（E test）4 耐藥篩選試驗(yàn)Drug screening test5 折點(diǎn)敏感試驗(yàn)Sensitive turning point test45（二）耐藥菌監(jiān)測試驗(yàn)Resistant to monitor test由于細(xì)菌存在一種或幾種耐藥機(jī)制，造成了細(xì)菌的多重耐藥性。單一的藥敏試驗(yàn)已不能完全表示細(xì)菌的耐藥性，必須進(jìn)行一些特殊的耐藥性監(jiān)測試驗(yàn)。 Because there is one or sev

39、eral bacterial resistance mechanisms, resulting in multiple drug resistance of bacteria. Single susceptibility test can not fully express the drug resistance of bacteria to be resistant to some special monitoring tests.461. 耐甲氧西林的葡萄球菌（methecillin resistance staphylococcus，MRS）1g甲氧西林(苯唑青霉素)紙片的抑菌圈直徑10

40、mm，或MIC4g/ml的金黃色葡萄球菌, 1g苯唑青霉素紙片的抑菌圈直徑17mm，或的凝固酶陰性葡萄球菌稱耐甲氧西林葡萄球菌。1g of methicillin (oxacillin) paper of the inhibition zone diameter 10mm, or MIC 4g/ml Staphylococcus aureus, 1g oxacillin disk inhibition zone diameter 17mm, or MIC 0.5g / ml of coagulase-negative methicillin-resistant Staphylococcus a

41、ureus, said47臨床意義 Clinical significance對所有-內(nèi)酰胺類藥物均無效,并對氨基糖苷類、大環(huán)內(nèi)酯類、克林霉素和四環(huán)素等抗生素多重耐藥。治療首選藥物為萬古霉素。 For all -lactam drugs are ineffective, and aminoglycosides, macrolides, clindamycin and tetracycline antibiotics such as multi-drug resistant. The preferred drug for the treatment of vancomycin.482. 氨基糖苷

42、類抗生素高耐藥腸球菌High-resistant enterococci aminoglycosides對氨基糖苷類和青霉素等作用于細(xì)胞壁的等抗生素聯(lián)用無效。 The role of aminoglycosides and penicillin and other antibiotics in the cell wall combined with null and void.493. 耐青霉素的肺炎鏈球菌Penicillin-resistant Streptococcus pneumoniae定義：1g苯唑青霉素紙片的抑菌圈直徑2g/ml應(yīng)視為耐青霉素肺炎鏈球菌（penicillin res

43、istant streptococcus pneumonia，PRSP）。Definition:1g oxacillin disk inhibition zone diameter 2g/ml should be regarded as penicillin-resistant Streptococcus pneumoniae 50臨床意義Clinical significancePRSP對氨芐西林、 氨芐西林/舒巴坦、 頭孢唑啉的臨床治療療效很差，治療時參考藥敏結(jié)果選擇藥物，經(jīng)驗(yàn)治療重癥感染時，可用頭孢曲松或頭孢噻肟聯(lián)合萬古霉素用藥。PRSP to ampicillin, ampicilli

44、n / sulbactam, cefazolin poor clinical efficacy of the treatment drug of choice when drug susceptibility results for reference, experience the treatment of severe infection, can be combined ceftriaxone or cefotaxime to vancomycin therapy.514. -內(nèi)酰胺酶的檢測 -lactamase detection-內(nèi)酰胺酶：可水解-內(nèi)酰胺類抗生素。-lactamase

45、s: hydrolyzed -lactam antibiotics.臨床意義：（1）流感嗜血桿菌、淋病奈瑟菌以及卡拉莫拉菌等陽性，表示對青霉素、氨芐西林以及阿莫西林耐藥。（2）葡萄球菌屬以及腸球菌屬等，陽性表示對青霉素、氨基組青霉素、羧基組青霉素以及脲基組青霉素耐藥。 Clinical significance: (1), Haemophilus influenzae, Neisseria gonorrhoeae, and karaoke-positive microorganisms in Mora, said to penicillin, ampicillin and amoxicilli

46、n resistance. (2) such as Staphylococcus and Enterococcus, the positive that penicillin, penicillin amino group, carboxyl group of penicillin and penicillin-resistant urea-based group.525. 產(chǎn)超廣譜-內(nèi)酰胺酶(extend spectrum -lactamase, ESBL)的腸桿菌科細(xì)菌Producing ESBL Enterobacteriaceae超廣譜-內(nèi)酰胺酶是由質(zhì)粒介導(dǎo)的- 內(nèi)酰胺酶，可水解青霉素

47、類、頭孢菌素和氨曲南，主要在大腸埃希菌和克雷伯菌屬等腸桿菌科細(xì)菌中產(chǎn)生。 Extended spectrum -lactamase mediated by plasmid -lactamases, can be hydrolyzed penicillins, cephalosporins and aztreonam, mainly in Escherichia coli and Klebsiella species and other Enterobacteriaceae Generated.53臨床意義Clinical significance產(chǎn)ESBL細(xì)菌，不論體外藥物敏感試驗(yàn)結(jié)果如何，對

48、青霉素類、頭孢菌素類和氨曲南治療均無效。ESBL producing bacteria, regardless of the outcome of in vitro drug sensitivity tests, to penicillin, cephalosporins and aztreonam treatment were ineffective.546. 耐萬古霉素的腸球菌Vancomycin resistant enterococci定義: 對30g萬古霉素紙片抑菌圈直徑19mm， 或MIC32g/ml應(yīng)視為耐萬古霉素腸球菌（vancomycin resistant enteroco

49、ccus，VRE）。 Definition: paper 30g vancomycin inhibition zone diameter 19mm, or MIC 32g/ml should be considered as VRE.55臨床意義Clinical significance耐萬古霉素腸球菌目前尚無有效的治療方法，但是對青霉素敏感的VRE可用青霉素和慶大霉素聯(lián)合治療，若對青霉素耐藥而不是高水平耐氨基糖苷類可用白霉素和慶大霉素。另外氯霉素、紅霉素、四環(huán)素（或多西環(huán)素、或米諾環(huán)素）及利福平可用于VRE株。Vancomycin resistant enterococci is curre

50、ntly no effective treatment, but the VRE to penicillin-sensitive penicillin and gentamicin combination therapy can be used, if not the high-level resistance to penicillin-resistant available aminoglycosides neomycin and celebrate great white Adriamycin. Addition of chloramphenicol, erythromycin and

51、tetracycline (or doxycycline, or minocycline) and rifampin can be used for VRE strains.56（三）病原菌耐藥基因的檢測Detection of pathogen resistance genes更早Earlier 確證Confirmed準(zhǔn)確Accurate金標(biāo)準(zhǔn)Gold standard57第三節(jié) 臨床感染常見病原體檢查Check the common pathogens of clinical infection 58感染性疾病指各種生物性病原體（病原微生物、寄生蟲）寄生人體所引起的傳染性感染疾病和非傳染性

52、感染疾病。Refers to a variety of infectious diseases, biological pathogens (pathogens, parasites) caused by human infectious parasitic diseases and non-communicable diseases.59 一、流行病學(xué)和臨床類型Epidemiology and clinical types60（一）流行病學(xué)Epidemiology新傳染病陸續(xù)被發(fā)現(xiàn)，老傳染病死灰復(fù)燃Been discovered new infectious diseases, the re

53、surgence of old diseases多重耐藥株Multi-drug resistant strains新醫(yī)療技術(shù)的開展The launching of new medical technologies61（二）臨床類型Clinical types臨床常見病原體為：細(xì)菌、真菌、病毒、支原體、衣原體、螺旋體、立克次體以及寄生蟲等。Common clinical pathogens: bacteria, fungi, viruses, mycoplasma, chlamydia, spirochetes, rickettsia, and parasites.62 二、檢查項(xiàng)目和臨床應(yīng)用

54、inspection items and clinical applications 63（一）細(xì)菌感染檢查項(xiàng)目的選擇The selection of checking projects on bacterial infection普通細(xì)菌：常采用直接鏡檢、分離培養(yǎng)與鑒定、抗原檢測。Common bacteria: direct microscopic examination is often used, Isolation and identification of antigen.病原體抗體檢測。Antibody detection of pathogens 難培養(yǎng)或培養(yǎng)要求高的細(xì)菌：綜合

55、運(yùn)用免疫學(xué)或分子生物學(xué)檢測，如結(jié)核分枝桿菌感染以及幽門螺桿菌感染等。Difficult for high culture or bacterial culture: the integrated use of immunology or molecular biology, such as Mycobacterium tuberculosis and Helicobacter pylori infection.細(xì)菌培養(yǎng)是最重要的確診方法。Bacterial culture is the most important diagnostic method.64（二）實(shí)驗(yàn)結(jié)果分析和臨床應(yīng)用Analy

56、sis and clinical application of experimental results顯微鏡檢查或分離培養(yǎng)的陰性結(jié)果不能完全排除感染；Microscopy or isolation and culture of negative results can not be completely ruled out infection共同抗原引起的交叉反應(yīng)；Antigenic cross-reactivity caused by the common核酸檢測的假陽性；False-positive nucleic acid detection血清學(xué)的動態(tài)檢測。Dynamic detec

57、tion of serological65第六節(jié) 醫(yī)院感染常見病原體檢測Detection of common pathogens of nosocomial infection 66醫(yī)院感染（nosocomial infection）：又稱醫(yī)院獲得性感染（hospital acquired infection），指患者在入院時不存在，也不處于潛伏期，而在醫(yī)院內(nèi)發(fā)生的感染，包括醫(yī)院內(nèi)獲得的而在出院后發(fā)病的感染。廣義的醫(yī)院感染對象不僅指住院患者，還包括門診病人、醫(yī)院職工、探視人員與陪護(hù)人員等。Nosocomial infection (nosocomial infection): also kn

58、own as hospital-acquired infection (hospital acquired infection), that does not exist on admission of patients, nor in the incubation period, while in the hospital infections occurred, including the hospital after discharge from hospital acquired disease in Infection. Generalized infection, not only

59、 by means of hospital inpatients, including outpatient, hospital staff, visiting officers and escort personnel.67 一、流行病學(xué)和臨床類型Epidemiology and clinical types68 （一）流行病學(xué)Epidemiology69病原學(xué)Pathogen細(xì)菌是最常見的病原體。 Bacterial is the most common pathogens.變化趨勢：革蘭氏陰性桿菌比例在增加，革蘭氏陽性球菌比例在減少。Trend: increasing the proportion of Gram-negative bacteria, Gram-positive cocci ratio decreased.罕見細(xì)菌變成流行株：陰溝腸桿菌、洋蔥假單孢菌，軍團(tuán)菌等Strains of bacteria become rare: Enterobacter cloacae, Pseu