【正文】 Protein chips 27 病原體特異性抗原檢測(cè)結(jié)果評(píng)價(jià) Evaluation of pathogenspecific antigen test results ? 如果能排除交叉抗原的影響，病原體抗原檢測(cè)可明確感染的病原體。 ? 為臨床提供體外抗微生物藥物敏感試驗(yàn)結(jié)果。 lactamase, extended spectrum 223。 38 ? 3 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。 ? 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 role of aminoglycosides and penicillin and other antibiotics in the cell wall bined with null and void. 49 3. 耐青霉素的肺炎鏈球菌 Penicillinresistant Streptococcus pneumoniae ? 定義： 1μg苯唑青霉素紙片的抑菌圈直徑 19mm且MIC2μg/ml應(yīng)視為耐青霉素肺炎鏈球菌（ penicillin resistant streptococcus pneumonia， PRSP）。 ? Definition: paper 30μg vanycin inhibition zone diameter ≤ 19mm, or MIC ≥ 32μg/ml should be considered as VRE. 55 臨床意義 Clinical significance ? 耐萬(wàn)古霉素腸球菌目前尚無(wú)有效的治療方法，但是對(duì)青霉素敏感的 VRE可用青霉素和慶大霉素聯(lián)合治療，若對(duì)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。 ? 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Analysis 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 pletely ruled out infection ? 共同抗原引起的交叉反應(yīng)； ? Antigenic crossreactivity caused by the mon ? 核酸檢測(cè)的假陽(yáng)性； ? Falsepositive nucleic acid detection ? 血清學(xué)的動(dòng)態(tài)檢測(cè)。 Similar to the basic principles and pathogen infection, but more should pay attention to the pollution of the normal flora and opportunistic pathogens in the hospital infection status. 76 1. 標(biāo)本采集和送檢基本原則 The basic principles of specimen collection and submission ? 及時(shí)采集標(biāo)本 ? Collect specimens in a timely manner ? 嚴(yán)格無(wú)菌操作 ? Strict aseptic ? 立即送出 ? Immediately sent ? 在抗菌藥物使用前 ? Before the use of antibiotics ? 合適的容器 ? Appropriate container ? 注明來(lái)源和目的 ? Indicate the source and destination ? 定量或半定量培養(yǎng) ? Quantitative or semiquantitative culture ? 分級(jí)報(bào)告和限時(shí)報(bào)告 ? Reports and limit grading report 77 2. 涂片鏡檢 Smear microscopy ? 痰標(biāo)本 ? Sputum 78 3. 分離培養(yǎng)鑒定法 Isolation and culture identification method ? 尿路感染 ? Urinary Tract Infection ? 手術(shù)切口感染 ? Surgical wound infection ? 大便培養(yǎng) ? Stool culture ? 血培養(yǎng) ? Blood culture 79 （二）醫(yī)院環(huán)境中細(xì)菌污染的監(jiān)測(cè)和消毒滅菌效果的監(jiān)測(cè) Bacterial contamination in the hospital environment monitoring and the monitoring of sterilization results 80 ? 定期對(duì)醫(yī)院環(huán)境進(jìn)行病原體監(jiān)測(cè)：空氣、物體表面、醫(yī)務(wù)人員手部； ? Regular monitoring of pathogens in hospital environment: air, surface, the medical staff of hand。 ? 醫(yī)院環(huán)境、未徹底消毒的醫(yī)療器械、血液制品等。 ? Antibody detection of pathogens ? 難培養(yǎng)或培養(yǎng)要求高的細(xì)菌：綜合運(yùn)用免疫學(xué)或分子生物學(xué)檢測(cè)，如結(jié)核分枝桿菌感染以及幽門螺桿菌感染等。 Extended spectrum βlactamase mediated by plasmid βlactamases, 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(duì)青霉素類、頭孢菌素類和氨曲南治療均無(wú)效。治療首選藥物為萬(wàn)古霉素。 ? Evaluation of new antibiotics and antibacterial activity of antibacterial spectrum. 42 方法 Methods ? 1 KB紙片瓊脂擴(kuò)散法（ KirbyBauer disc agar diffusion method） 43 參照 NCCLS標(biāo)準(zhǔn) NCCLS standard reference ? 敏感（ susceptible， S）：表示測(cè)試菌能被測(cè)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 。 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 223。 內(nèi)酰胺酶(ESBL)、 Ⅰ 類 223。 ? 陽(yáng)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。 ? 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 inclusion bodies in host cell。 ? Draw serum after natural coagulation of blood, then inactivate plement. 17 二、標(biāo)本的實(shí)驗(yàn)室質(zhì)量評(píng)估標(biāo)準(zhǔn) Two. Standard of laboratory quality assessment of specimens 18 檢驗(yàn)申請(qǐng)單的基本內(nèi)容 The basic content of an application for examination ? The patient,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 specimens ? 1 The information on the label does not exist or not match the information on the