臨床検査58巻10号

2014年10月発行

今月の特集1 血液培養検査を感染症診療に役立てる

血液培養の正しい採取方法とは

著者： 古市宗弘¹ 宮入烈¹

所属機関： ¹国立成育医療研究センター　感染症科

ページ範囲：P.1118 - P.1123

●血液培養を採取する際には，感度を上昇させ，コンタミネーションを減らす努力が必要である．

●感度を上げるためには，十分な採血量（1回当たり好気ボトルに10mL，嫌気ボトルに10mLの計20mL）を2セット以上採取する．

●コンタミネーションを減らすためには，アルコール綿の後にポビドンヨードまたはクロルヘキシジンで消毒し，滅菌手袋を着用し静脈穿刺で採血を行う．

参考文献

1）Tokuda Y, Miyasato H, Stein GH, et al：The degree of chills for risk of bacteremia in acute febrile illness. Am J Med　118：1417，2005

2）Coburn B, Morris AM, Tomlinson G, et al：Does this adult patient with suspected bacteremia require blood cultures? JAMA　308：502-511，2012

3）Freifeld AG, Bow EJ, Sepkowitz KA, et al：Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis　52：e56-e93，2011

4）Bayer AS, Bolger AF, Taubert KA, et al：Diagnosis and management of infective endocarditis and its complications. Circulation　98：2936-2948，1998

5）Mermel LA, Maki DG：Detection of bacteremia in adults: consequences of culturing an inadequate volume of blood. Ann Intern Med　119：270-272，1993

6）Cockerill FR 3rd, Wilson JW, Vetter EA, et al：Optimal testing parameters for blood cultures. Clin Infect Dis　38：1724-1730，2004

7）Baron EJ：Cumitech 1C, Blood Cultures IV, American Society for Microbiology Press, Washington, DC, p4, 2005

8）Kellogg JA, Manzella JP, Bankert DA：Frequency of low-level bacteremia in children from birth to fifteen years of age. J Clin Microbiol　38：2181-2185，2000

9）Kellogg JA, Ferrentino FL, Goodstein MH, et al：Frequency of low level bacteremia in infants from birth to two months of age. Pediatr Infect Dis J　16：381-385，1997

10）Clinical and Laboratory Standards Institute (CLSI)：Principles and Procedures for Blood Cultures; Approved Guideline. CLSI document M47-A, CLSI, Wayne PA, 2007

11）笠井正志，志馬伸朗，齋藤昭彦，他：本邦複数の小児医療施設における血液培養採取量と検出率に関する観察研究．感染症誌　87：620-623，2013

12）Shoji K, Komuro H, Watanabe Y, et al：The utility of anaerobic blood culture in detecting facultative anaerobic bacteremia in children. Diagn Microbiol Infect Dis　76：409-412，2013

13）Lee A, Mirrett S, Reller LB, et al：Detection of bloodstream infections in adults: how many blood cultures are needed? J Clin Microbiol　45：3546-3548，2007

14）Weinstein MP, Towns ML, Quartey SM, et al：The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis　24：584-602，1997

15）Reimer LG, Wilson ML, Weinstein MP：Update on detection of bacteremia and fungemia. Clin Microbiol Rev　10：444-465，1997

16）Buttery JP：Blood cultures in newborns and children: optimising an everyday test. Arch Dis Child Fetal Neonatal Ed　87：F25-F28，2002

17）Sarkar S, Bhagat I, DeCristofaro JD, et al：A study of the role of multiple site blood cultures in the evaluation of neonatal sepsis. J Perinatol　26：18-22，2006

18）Karahan ZC, Mumcuoglu I, Guriz H, et al：PCR evaluation of false-positive signals from two automated blood-culture systems. J Med Microbiol　55（Pt 1）：53-57，2006

19）Qian Q, Tang YW, Kolbert CP, et al：Direct identification of bacteria from positive blood cultures by amplification and sequencing of the 16S rRNA gene: evaluation of BACTEC 9240 instrument true-positive and false-positive results. J Clin Microbiol　39：3578-3582，2001

20）O’Grady NP, Alexander M, Burns LA, et al：Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control　39（4 Suppl 1）：S1-S34，2011

21）Kiyoyama T, Tokuda Y, Shiiki S, et al：Isopropyl alcohol compared with isopropyl alcohol plus povidone-iodine as skin preparation for prevention of blood culture contamination. J Clin Microbiol　47：54-58，2009

22）Kim NH, Kim M, Lee S, et al：Effect of routine sterile gloving on contamination rates in blood culture: a cluster randomized trial. Ann Intern Med　154：145-151，2011

23）Spitalnic SJ, Woolard RH, Mermel LA：The significance of changing needles when inoculating blood cultures: a meta-analysis. Clin Infect Dis　21：1103-1106，1995

24）Snyder SR, Favoretto AM, Baetz RA, et al：Effectiveness of practices to reduce blood culture contamination: a Laboratory Medicine Best Practices systematic review and meta-analysis. Clin Biochem　45（13-14）：999-1011，2012

25）Mermel LA, Allon M, Bouza E, et al：Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis　49：1-45，2009