临床细菌检验快速方法应用进展
三、对某些常规方法重新进行评价，减少不必要的检验时间
分泌物及无菌部位采集的标本用肉汤增菌，是目前实验室普遍采用的检验方法，增菌与不增菌差异有多大以及增菌后分离的病原菌临床意义如何，并未引起关注。最近Morris等［18］对体液和组织标本进行回顾性分析发现，356例直接平板培养阴性，而经肉汤增菌分离出的细菌和真菌中，73%为污染菌，其中6例污染菌导致应用抗生素。在27%的感染菌中，仅3%对临床治疗产生影响。Derby等［19］对273份脓拭子标本研究证实，27份标本分离出细菌或真菌，认为19株有临床意义，其中仅2份标本直接平板培养为无菌生长。病历调查证实，仅有2例病人的培养结果对临床治疗产生了影响。因此认为增菌培养除无菌部位如血液、脑脊液、透析液、组织标本外，其他标本如分泌物等一般无需增菌，因此可缩短检验时间。
参考文献1 Dalton mT, Haldane DJ, MacDonald J. Rapid identification of Candida albicans using4-methylumbelliferyl-N-acetyl-β-D-a glactosaminide. Diagn Micrbiol Infect Dis, 1989,12：521-523.
2 Willinger b, Manafi M, Rotter ML. Comparison of rapid methods using fluorogenic-chromogenic assays for detecting Candida albicans. Lett Appl microbiol, 1994,18：47-49.
3 Freydiere aM, Buchaille L, Gille Y. Comparison of three commercial media for direct identification of Candida species in clinical specimens. Eur J Clin Microbiol infect Dis, 1997,16：464-467.
4 Odds fC, Bernaerts R. CHROMagar Candida, a new differential isolation medium for presumptive identification of clinically important Candida species. J Clin microbiol, 1994,32：1923-1929.
5 Hansen w, Yourassowsky E. Detection of β-glucuronidase in lactose-fermenting members of the family Enterobacteriaceae and its presence in bacterial urine cultures. J Clin Microbiol, 1984,20：1177-1179.
6 Trepeta rW, Edberg SC. Methylumbelliferyl-β-D-glucuronide-based medium for rapid isolation and identification of Escherichia coli. J Clin microbiol, 1984,19：172-174.
7 Merlino j, Siarakas S, Robertson GJ, et al. Evaluation of CHROMagar Orientation for differentiation and presumptive identification of gram-negative bacilli and enterococcus species. J Clin Microbio, 1996,34：1788-1793.
8 Samra z, Heifetz M, Talmor J, et al. Evaluation of use of a new chromogenic agar in detection of urinary tract pathogens. J Clin Microbiol, 1998,36：990-994.
9 Mir n, Sanchez M, Baquero F, et al. Soft salt-mannitol agar-cloxacillin test: a highly specific beside screening test for detection of colonization with methicillin-resistant Staphylococcus aureus. J Clin Microbiol, 1998,36：986-989.
10 Rambach a. New plate medium for facilitated differentiation of Salmonella spp. from proteus spp. and other enteric bacteria. Appl Environ Microbiol, 1990,56：301-303.
11 Dusch H, altwegg M. Comparison of Rambach agar, Sm-ID medium, and Hektoen enteric agar for primary isolation of non-typhi Salmonellae from stool samples. J Clin microbiol, 1993,31:410-412.
12 Siau H, yuen KY, Ho PL, et al. Identification of Acinetobacters on blood agar in presence of D-glucose by unique browning effect. J Clin Micrbiol, 1998,36：1404-1407.
13 Clark aG, McLauchlin J. Simple color tests based on an alanyl peptidase reaction which differentiate Listeria monocytogenes from other Listeria species. J Clin microbiol, 1997,35：2155-2156.
14 Inoue K, miki K, Tamura K, et al. Evaluation of L-pyrrolidonyl peptidase paper strip test for differentiation of members of the family Enterobacteriaceae, particularly salmonella spp. J Clin Microbiol, 1996,34：1811-1812.
15 Fedorko dP, Williams EC. Use of cycloserine-cefoxitin-fructose agar and L-proline aminopeptidase (PRO Discs) in the rapid identification of Clostridium difficile. j Clin Microbiol, 1997,35：1258-1259.
16 Perry jL, Miller GR, Carr DL. Rapid colorimetric identification of Candida albicans. J clin Microbiol, 1990,28：614-615.
17 Dealler sF. Candida albicans colony identification in 5 minutes in a general microbiology laboratory. J Clin Microbiol, 1991,29：1081-1082.
18 Morris aJ, Wilson SJ, Marx CE, et al. Clinical impact of bacteria and fungi recovered only from broth cultures. J Clin Microbiol, 1995,33：161-165.
19 Derby P, davies R, Oliver S. The value of including broth cultures as part of a routine culture protocol. J Clin Microbiol, 1997,35：1101-1102.
