Zusammenfassung
Der Nachweis von Mikroorganismen im Blut erfordert nicht nur die Verwendung von verläßlichen Methoden durch den Mikrobiologen sondern neben einer einwandfreien Entnahmetechnik auch die Auswahl des richtigen Zeitpunktes und eine ausreichende Anzahl von Blutkulturen durch den Kliniker. Am besten bewährt es sich, Blut direkt am Krankenbett in Kulturmedien einzubringen, denen gerinnungshemmende, die mikrobizide Wirkung des Blutes (Eigenmikrobizidie und Fremdstoffe) neutralisierende und osmotisch stabilisierende Stoffe zugesetzt sind. Natrium-Polyanetholsulfonat („Liquoid“) hat sich bis heute als geeignetstes Additivum bewährt. Ein Blutkulturverfahren muß sowohl aeroben, anaeroben wie auch zellwandgeschädigten Keimen das Wachstum ermöglichen. Für eine weniger arbeitsintensive Auslese von positiven Blutkulturen sind heute moderne Methoden wie die Radiometrie, die Impedanzmessung und die Mikrokalorimetrie in Verwendung oder Entwicklung. Durch Gegenstromimmunelektrophorese, den Limulus-Test und gaschromatographische Techniken lassen sich im Blut kreisende Antigene, Zellwandbestandteile bzw. Stoffwechselprodukte von Bakterien und Pilzen auch ohne Kultur nachweisen. Anreicherungstechniken wie Filtration und Zentrifugation werden heute ebenfalls für die sicherere und schnellere Entdeckung von Septikämien weiterentwickelt.
Summary
To detect microorganisms in the blood it is necessary not only that the microbiologist uses reliable methods, but also that the clinician takes a sufficient number of blood samples at the right point in time using a correct method for drawing the blood. The best results are obtained if the blood sample is transferred to the culture media at the bedside. The media should contain anticoagulants, osmosis stabilizers and preparations to neutralize the microbial action of the blood (caused by intrinsic and extrinsic factors). Up until now sodium polyanetholsulfonate (“Liquoid”) has proved to be the most suitable additive. The procedure used for blood culturing must enable growth of aerobes, anaerobes and microbes with cell-wall damage. Today, modern methods such as radiometry, impedance measurement and microcalorimetry are used or are in the process of being developed which facilitate screening for positive cultures. Antigens, cell-wall constituents and metabolites of bacteria and fungi present in the blood stream can be detected by means of counter-immunoelectrophoresis, the Limulus test and gas chromatography, without culturing being necessary. Concentration techniques such as filtration and centrifugation are also being refined to enable a more reliable and earlier detection of septicemia.
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Rotter, M. Mikrobiologische Diagnostik von Septikämien. Infection 5, 55–59 (1977). https://doi.org/10.1007/BF01639113
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DOI: https://doi.org/10.1007/BF01639113