1、Blood Stream Infection 血流感染 北京协和医院 感染科 侍效春 感 染 炎症 病原体 器官功能衰竭 (OD) 序贯性器官功能衰竭评估（ SOFA）评分 2 脓毒症(sepsis) 感染 OD 感染性休克（ septic shock） = Sepsis + 出现补液无法纠正的低血压以及血乳酸水平 2mmol/l 多脏器功能不全综合征 (MODS) Sequential Organ Failure Assessment (SOFA ) 器官系统 指标 评分 呼吸系统 PaO2/FiO2 mmHg 400 300 200+机械通气 100+机械通气 1 2 3 4 神经系统 G
2、lasgow评分 13-14 10-12 6-9 6 1 2 3 4 心血管系统 药物剂量 ug/kg.min 平均动脉压 70mmHg 多巴酚丁胺（任何剂量）或多巴胺 5 多巴胺 5或（去甲）肾上腺素 0.1 多巴胺 15或（去甲）肾上腺素 0.1 1 2 3 4 肝脏 胆红素 umol/l 20-32 33-101 102-204 204 1 2 3 4 凝血系统 血小板 109/L 150 100 50 20 1 2 3 4 肾脏 肌酐 umol/l或者尿量 ml/d 110-170 171-299 300-440或 500ml/d 440或 200ml/d 1 2 3 4 快速 SOF
3、A评分 （ quick SOFA, qSOFA） 呼吸频率 22次 /min 意识改变 收缩压 100mmHg 如当中有二个参数变化符合，则认为有 OD INFECTION OD SEPSIS BACTEREMIA FUNGEMIA PARASITEMIA VIREMIA OTHER Definition BSI is defined in a patient with a clinically important blood culture positive for a bacterium or fungus. When a culture is unexpectedly positive
4、(in the absence of signs or symptoms) or when only one of several cultures is positive for a microorganism, it can often be dismissed as a contaminant. A blood stream infection must meet the conditions in one of the following criteria: Criterion 1 (recognized pathogens; non neonatal intensive care)
5、Isolation of one or more recognized bacterial or fungal pathogens from one or more blood cultures (e.g., Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, Klebsiella, Proteus, Salmonella species, Candida albicans). Criterion 2 (potential contaminants in patients aged 1 year) The pat
6、ient has at least one of the following signs and symptoms within 24 hours of a positive blood culture being collected: Fever (38 ) Chills or rigors Hypotension and at least one of the following: There is isolation of the same potential contaminant from two or more blood cultures drawn on separate oc
7、casions within a 48 hour period (isolates identified by suitable microbiological techniques) There is isolation of a potential contaminant from a single blood culture drawn from a patient with an intravascular line (within 48 hours of the episode) and appropriate antimicrobial therapy against that i
8、solate is commenced. Criterion 3 (potential contaminants in patients aged 38 ) hypothermia (30秒钟 1%2%碘酊 30秒或 10%碘伏消毒 60秒 70%酒精脱碘 一步法 葡萄糖酸洗必泰作用 30 s，或 70%异丙醇消毒后自然干燥，但不适用于 2个月以内的新生儿。 培养瓶 70%酒精消毒血培养瓶橡皮塞 ,待干 60秒。或 70%异丙醇消毒干燥 更换针头不推荐 28 血培养采集数量 采血套数及血量 1套 (20ml) 2套 (40ml) 3套 (60ml) 检出率 65% 80% 96% Cockrill2004年报告 :163位病人 ,血培养 培养瓶中血量 成人： 810ml 儿童： 15ml 儿童菌血症每 ml血中含菌量高于成人 血液与肉汤比例为 1:51:10 30
