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1、1,临床常见病原体检测 Examination of clinical common pathogens,呼吸内科 熊维宁 Department of Respiratory Medicine Xiong, Weining,2,目的 Objective,确定感染的发生和性质，及早明确诊断； Determine the occuring and nature of infection, and make diagnosis early; 尽早选择适当的治疗方案； Select the appropriate treatment as soon as possible; 采取有效的预防措施，防止感
2、染可能广泛传播所造成的危害。 Take effective prevention measures to prevent infection to cause widespread damage.,3,基本程序 Basic Procedures,正确采集和运送标本； Correct collection and transportation of specimens 初步诊断：直接镜检，免疫学和分子生物学检测； Initial diagnosis: direct microscopy, immunology and molecular biology examination; 确定诊断：病原体
3、的分离、鉴定及药敏实验，报告结果； Determined diagnosis: pathogen isolation, identification and sensitivity test, reporting results; 合理用药 Appropriate drug use,4,第一节 Section One,标本的采集运送、实验室评价和检查方法 Transportation and collection of specimen, laboratory evaluation and examination methods,5,一、标本采集和运送 One. Collection and
4、transportation of Specimen,6,基本原则 Basic principles,根据病史与临床表现确定标本采集的时间、部位、种类和数量，尽量采集病变明显部位标本； According to history and clinical manifestations to determine the collection time, location, type and quantity of specimens, collect specimens at significant parts of lesions; 无菌操作，防止污染； Use aseptic techniqu
5、e to prevent contamination; 采取适宜的方式进行储存，尽快送检； Appropriate way to store, as soon as possible for examination; 要视所有标本为传染品，高度危险性的标本要有明显标识，急症或危重患者标本要特别注明。 To view all the specimens for infectious, high risk specimens should be clearly marked, acute or critically ill patient specimens should be specified
6、.,9,（二）尿液 (Two) Urine,无菌采集中段尿； Sterile collection of mid-portion urine; 如考虑厌氧菌感染，采取膀胱穿刺法采集标本，无菌厌氧小瓶运送； If consideration of anaerobic infections, apply bladder puncture to collect specimens, transport them with sterile anaerobic vial; 排尿困难者考虑导尿采集标本。 Apply catheterization to collect specimens for dysu
7、ria patients.,10,（三）粪便 (Three) Stool,挑取脓、血或粘液部分于清洁容器中送检； Pick pus, blood or mucus from stoll into clean containers for examination; 排便困难者或婴儿采用直肠拭子采集，置于有保存液的试管内送检； Apply rectal swab for infants or difficult defecation, place it with preservation solution in the test tube for examination; 怀疑霍乱弧菌感染引起的腹
8、泻，将标本置于碱性蛋白胨水或卡-布（Cary-Blair）运送培养液送检； Suspected infections caused by Vibrio cholerae, the specimens were placed in alkaline peptone water or card - cloth (Cary-Blair) transport medium for examination; 传染性腹泻应连续送检3次。 Continuous examination 3 times for infectious diarrhea.,11,（四）呼吸道标本 (Four) Respirator
9、y specimens,类型：鼻咽拭子，痰和经气管采集的标本； Types: nasopharyngeal swab, sputum, and specimens collected through tracheal 上呼吸道存在正常菌群，在采集标本与结果分析时应予考虑。 There is normal flora in upper respiratory tract, the specimens collection and results analysis should be considered.,12,（五）脑脊液与其他无菌体液 (Five) Cerebrospinal fluid a
10、nd other sterile body fluids,脑脊液应立即保温送检或床边接种； CSF should be transported immediately with insulation or cultured bedside； 胸腔积液、腹腔积液和心包积液等应采集较大量标本送检，离心后再接种培养。 Pleural effusion, ascites and pericardial effusion with a large volume should be collected, centrifugated and then cultured.,13,（六）眼、耳部标本 (Six)
11、 Eye, ear specimens,拭子采样 Swab samples,14,（七）泌尿生殖道标本 (Seven) Urogenital specimens,男性：无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：无菌采集阴道或宫颈分泌物。 Female: vaginal or cervical secretions collected aseptically.,15,（八）创伤、组织和脓肿标本 (Eight) Trauma, organization, and
12、abscess specimens,对损伤范围较大的创伤，从不同部位采集多份标本； On a wider range of trauma injuries, specimens collected from many different parts; 采集部位应首先清除污物、消毒皮肤； Firstly remove dirt, disinfect the skin around collection site; 标本较少则需加入无菌生理盐水以防干燥； Fewer samples must be added to sterile saline to prevent drying; 开放性脓肿及脓
13、性分泌物：用无菌棉纤采取脓液或病灶深部分泌物； Open abscess and purulent secretions: collect deep discharge pus or lesions with sterile cotton fibers; 封闭性脓肿用注射器抽取； Collect specimen in closed abscess with a syringe; 怀疑厌氧菌感染，应隔绝空气采集。 Suspected anaerobic infections, collection should be isolated from air.,16,（九）血清 (Nine) Ser
14、um,用于检测特异性抗体； For the detection of specific antibodies; 血液自然凝固后吸取血清，灭活补体。 Draw serum after natural coagulation of blood, then inactivate complement.,17,二、标本的实验室质量评估标准 Two. Standard of laboratory quality assessment of specimens,18,检验申请单的基本内容 The basic content of an application for examination,The pat
15、ient,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,标本接收和拒收准则 Reception and rejection criteria for specimens,1 The information on the l
16、abel does not 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.,20,5 Contaminated samples; 6 The quantity of specimen is insufficient for testing; 7 Duplicate submission of specimens (except blood cultures); 8 The transportation of specimens of severe infectious diseases should comply with the relevant rules.,21,三、检查方法 Three. Examination methods,
