2025年《感染性发热临床检验路径专家共识》解读

doi:10.16150/j.1671-2870.2026.03.003

摘要/Abstract

摘要：

为建立科学、规范、可操作的感染性发热临床检验路径，解决当前感染性发热临床检验中存在的项目选择盲目、检测时机不当及多学科协作不足等问题，上海市微生物学会临床微生物学专业委员会、上海市医学会检验医学专科分会及分子诊断专科分会联合组织专家组，整合不同医疗机构感染性发热临床诊疗现状，结合循证医学证据与我国临床实践特点，参考2017年《发热待查诊治专家共识》等现有共识、指南及国内外相关法规标准，制定了2025年《感染性发热临床检验路径专家共识》。该共识的修订统一了感染性发热检验路径标准，规范了诊疗行为，优化了医疗资源配置，提升了诊疗质量，解决了临床中检验项目滥用与缺失并存、多学科协作不畅、不同层级医疗机构检验衔接断层等实际难题。本文围绕该共识修订背景、实施难点及临床意义等方面展开解读，针对共识新增的感染性发热鉴别诊断与临床特征界定、高危人群精准检测策略、分层级检验策略、新型实验室诊断技术应用等内容，重点解读其分层级检验策略、特殊病原体检测技术优选、高危人群个体化诊疗及多学科协作机制等核心内容，同时对于当前共识实施中存在的医疗资源配置不均衡、多学科协作不完善、新技术应用局限等问题进行探讨，并对未来随着检测技术革新，持续完善共识、推动感染性疾病诊疗水平进步进行展望，以期为各级医疗机构临床医生和检验人员提供切实可行的实践指导，进一步提升感染性发热的诊断效率、精准度，推动临床诊疗工作规范化发展。

关键词: 感染性发热, 临床检验路径, 精准诊断, 多学科协作

Abstract:

To establish a scientific, standardized, and operable clinical laboratory pathway for infectious fever, and to address current problems such as blind selection of testing items, inappropriate testing timing, and inadequate multidisciplinary collaboration in clinical testing for infectious fever, the Clinical Microbiology Committee of the Shanghai Society for Microbiology and the Laboratory Medicine Branch and Molecular Diagnosis Branch of the Shanghai Medical Association jointly organized an expert panel. The panel integrated the current status of clinical diagnosis and treatment of infectious fever across different medical institutions, combined evidence-based medical evidence with the characteristics of clinical practice in China, and referred to existing consensuses and guidelines (such as the 2017 Expert Consensus on the Diagnosis and Treatment of Fever of Unknown Origin), as well as relevant domestic and international regulations and standards, to formulate the Expert Consensus on the Clinical Testing Pathway for Infectious Fever. The revision of this consensus unified the standards for the clinical testing pathway for infectious fever, standardized diagnosis and treatment behaviors, optimized allocation of medical resources, improved the quality of diagnosis and treatment, and addressed practical problems such as coexistence of overuse and underuse of testing items, poor multidisciplinary collaboration, and disconnection of testing services among medical institutions at different levels. This article interprets the revision background, implementation difficulties, and clinical significance of the consensus. It focuses on newly added contents such as the differential diagnosis and clinical feature definition of infectious fever, precise testing strategies for high-risk populations, hierarchical testing strategies, and application of novel laboratory diagnostic technologies. Additionally, it highlights core topics including hierarchical testing strategies, optimal selection of special pathogen detection technologies, individualized diagnosis and treatment for high-risk populations, and multidisciplinary collaboration mechanisms. Meanwhile, this article discusses current challenges in the implementation of the consensus, including unbalanced allocation of medical resources, inadequate multidisciplinary collaboration, and limitations in the application of new technologies. It also provides an outlook on the continuous improvement of the consensus with advances in testing technologies and promotion of progress in the diagnosis and treatment of infectious diseases, aiming to provide practical guidance for clinicians and laboratory personnel in medical institutions at all levels, further improve the diagnostic efficiency and accuracy of infectious fever, and promote standardized development of clinical diagnosis and treatment.

Key words: Infectious fever, Clinical testing pathway, Precision diagnosis, Multidisciplinary collaboration

中图分类号:

R51
R446

朱召芹, 吴文娟. 2025年《感染性发热临床检验路径专家共识》解读[J]. 诊断学理论与实践, 2026, 25(03): 268-277.

ZHU Zhaoqin, WU Wenjuan. Interpretation of 2025 Expert Consensus on Clinical Testing Pathway For Infectious Fever[J]. Journal of Diagnostics Concepts & Practice, 2026, 25(03): 268-277.

图/表 2

图1

表1

参考文献 49

[1]	《中华传染病杂志》编辑委员会. 发热待查诊治专家共识[J]. 中华传染病杂志, 2017, 35(11):641-655.
	Editorial board of Chinese Journal of infectious diseases. Expert consensus on diagnosis and treatment of fever[J]. Chin J Infect Dis, 2017, 35(11):641-655.
[2]	吴晓飞. 发热诊断的临床思路与急诊处理[J]. 中华全科医学, 2021, 19(12):1989-1990.
	WU X F. Clinical thinking of fever diagnosis and emergency treatment[J]. Chin J Gen Pract, 2021, 19(12):1989-1990.
[3]	上海市微生物学会临床微生物学专业委员会,上海市医学会检验医学专科分会,上海市医学会危重病专科分会. 血流感染临床检验路径专家共识[J]. 中华传染病杂志, 2022, 40(8):457-475.
	Clinical Microbiology Division of Shanghai Society of Microbiology; Shanghai Society of Laboratory Medicine, Shanghai Medical Association; Shanghai Society of Critical Care Medicine, Shanghai Medical Association. Expert consensus on clinical laboratory strategies for bloodstream infection[J]. Chin J Infect Dis, 2022, 40(8):457-475.
[4]	中国医疗保健国际交流促进会急诊医学分会,中华医学会急诊医学分会,中国医师协会急诊医师分会,等. 中国"脓毒症早期预防与阻断"急诊专家共识[J]. 中华危重病急救医学, 2020, 32(5):518-530.
	Emergency Medicine Branch of Chinese Medical Care International Exchange Promotion Association; Emergency Medical Branch of Chinese Medical Association; Chinese Medical Doctor Association Emergency Medical Branch. Consensus of Chinese experts on early prevention and blocking of sepsis[J]. Chin Crit Care Med, 2020, 32(5):518-530. doi: 10.3760/cma.j.cn121430-20200514-00414 pmid: 32576341
[5]	《中华传染病杂志》编辑委员会. 中国宏基因组学第二代测序技术检测感染病原体的临床应用专家共识[J]. 中华传染病杂志, 2020, 38(11):681-689.
	Editorial Board of Chinese Journal of Infectious Diseases. Clinical practice expert consensus for the application of metagenomic next generation sequencing[J]. Chin J Infect Dis, 2020, 38(11):681-689.
[6]	《美罗培南治疗药物监测中国专家共识》编写组,中国药师协会治疗药物监测药师分会. 美罗培南治疗药物监测中国专家共识[J]. 中国药房, 2025, 36(16):1958-1967.
	Writing Group of the Chinese Expert Consensus for Therapeutic Drug Monitoring of Meropenem; Society of Therapeutic Drug Monitoring Pharmacists of Chinese Pharmacists Association. Chinese expert consensus for therapeutic drug monitoring of meropenem[J]. Chin Pharm, 2025, 36(16):1958-1967.
[7]	上海市微生物学会临床微生物学专业委员会,上海市医学会检验医学专科分会,上海市医学会分子诊断专科分会. 感染性发热临床检验路径专家共识[J]. 中华检验医学杂志, 2026, 49(1):35-46.
	Clinical Microbiology Professional Committee Laboratory of Shanghai Society for Microbiology; Medicine Branch of Shanghai Medical Association; Molecular Diagnostics Branch of Shanghai Medical Association. Expert consensus on the clinical laboratory testing pathway for infectious fever[J]. Chin J Lab Med, 2026, 49(1):35-46.
[8]	APISARNTHANARAK A, BIN KIM H, MOORE L S P, et al. Utility and applicability of rapid diagnostic testing in antimicrobial stewardship in the Asia-Pacific Region: A delphi consensus[J]. Clin Infect Dis, 2022, 74(11):2067-2076. doi: 10.1093/cid/ciab910 URL
[9]	YANG J, WANG Q, WANG S, et al. Unusual drug fever caused by imipenem/cilastatin and a review of literature[J]. Heart Surg Forum, 2019, 22(2):E119-E123.
[10]	ELMAKKI E E, ALI MADKHALI M, ORAIBI O, et al. Transfusion-associated graft-versus-host disease in adults[J]. Cureus,2023:e44148.
[11]	FENG J, CHEN Q, YU M, et al. Incomplete Kawasaki di-sease presenting primarily with cough: A case report and brief literature review[J]. BMC Pediatr, 2025, 25(1):632. doi: 10.1186/s12887-025-05957-2
[12]	CELIK I H, HANNA M, CANPOLAT F E, et al. Diagnosis of neonatal sepsis: The past, present and future[J]. Pediatr Res, 2022, 91(2):337-350. doi: 10.1038/s41390-021-01696-z
[13]	REHN M, CHEW M S, OLKKOLA K T, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock in adults 2021 - endorsement by the Scandinavian society of anaesthesiology and intensive care medicine[J]. Acta Anaesthesiol Scand, 2022, 66(5):634-635. doi: 10.1111/aas.14045 pmid: 35170043
[14]	HU B, JI W, BO L, et al. How to improve the care of septic patients following “Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021”?[J]. J Intensive Med, 2023, 3(2):144-146. doi: 10.1016/j.jointm.2022.08.001 URL
[15]	O’GRADY N P, ALEXANDER E, ALHAZZANI W, et al. Society of critical care medicine and the infectious di-seases society of America guidelines for evaluating new fever in adult patients in the ICU[J]. Crit Care Med, 2023, 51(11):1570-1586. doi: 10.1097/CCM.0000000000006022 URL
[16]	SANDHERR M, STEMLER J, SCHALK E, et al. 2024 update of the AGIHO guideline on diagnosis and empirical treatment of fever of unknown origin (FUO) in adult neutropenic patients with solid tumours and hematological malignancies[J]. Lancet Reg Health Eur,2025,51:101214.
[17]	OGOINA D. Fever, fever patterns and diseases called ‘fever’-a review[J]. J Infect Public Health, 2011, 4(3):108-124. doi: 10.1016/j.jiph.2011.05.002 URL
[18]	TONG Y, WANG Q, FU Y, et al. Molecular identification of severe fever with thrombocytopenia syndrome viruses from tick and bitten patient in Southeast China[J]. Virol J, 2020, 17(1):122. doi: 10.1186/s12985-020-01391-1 pmid: 32758245
[19]	NAQVI S A H, ABBAS A, HASNAIN A, et al. Advancing fungal phylogenetics: Integrating modern sequencing, dark taxa discovery, and machine learning[J]. Arch Microbiol, 2025, 207(9):192. doi: 10.1007/s00203-025-04392-2 pmid: 40643763
[20]	World Health Organization. Guidelines for clinical mana-gement of arboviral diseases: dengue, chikungunya, Zika and yellow fever[M]. Geneva:WHO, 2025.
[21]	IULIANO A D, ROGUSKI K M, CHANG H H, et al. Estimates of global seasonal influenza-associated respiratory mortality: A modelling study[J]. Lancet, 2018, 391(10127):1285-1300. doi: S0140-6736(17)33293-2 pmid: 29248255
[22]	DEINHARDT-EMMER S, CHOUSTERMAN B G, SCHEFOLD J C, et al. Sepsis in patients who are immunocompromised: Diagnostic challenges and future therapies[J]. Lancet Respir Med, 2025, 13(7):623-637. doi: 10.1016/S2213-2600(25)00124-9 URL
[23]	TEH B W, MIKULSKA M, AVERBUCH D, et al. Consensus position statement on advancing the standardised reporting of infection events in immunocompromised patients[J]. Lancet Infect Dis, 2024, 24(1):e59-e68. doi: 10.1016/S1473-3099(23)00377-8 URL
[24]	OHIA C M D, FALODUN O I, ADEBUDO L I, et al. A one health perspective on multidrug-resistant bacterial infections: Integrated approaches for surveillance, policy and innovation[J]. Front Cell Infect Microbiol, 2025,15:1614232.
[25]	MA D, CAI F, ZHANG T. Advances in the detection of drug-resistant bacteria: Current trends and innovations[J]. Eur J Clin Microbiol Infect Dis, 2026, 45(1):1-17. doi: 10.1007/s10096-025-05250-1
[26]	EBELL M H, RAHMATULLAH I, HULME C, et al. Accuracy of individual signs and symptoms and case definitions for the diagnosis of influenza in different age groups: A systematic review with meta-analysis[J]. BMJ Open, 2025, 15(3):e067574. doi: 10.1136/bmjopen-2022-067574 URL
[27]	PARRI N, PANTELL R H, CARROL E D, et al. Procalcitonin in pediatric emergency medicine[J]. Adv Pediatr, 2025, 72(1):25-40. doi: 10.1016/j.yapd.2025.01.002 pmid: 40582754
[28]	国家感染性疾病医疗质量控制中心, 中国初级卫生保健基金会儿科专家委员会, 中国医药教育协会儿科专业委员会, 等. 发热患儿就诊流程规范化管理专家共识[J]. 中华实用儿科临床杂志, 2023, 38(12):898-904.
	China National Medical Quality Control Center for Infectious Diseases; China Primary Health Care Education Foundation Committee on Pediatrics; China Medicine Education Association Committee on Pediatrics, et al. Expert consensus on standardized management of medical process for febrile children[J]. Chin J Appl Clin Pediatr, 2023, 38(12):898-904.
[29]	ESTEBAN J, PATEL R, AGUILERA-CORREA J J, et al. Optimized use and performance of culture for periprosthetic joint infection diagnosis: A comprehensive literature review[J]. Clin Microbiol Rev, 2025, 38(4):e00054-e00025.
[30]	YANG X, FAN Y, XU X, et al. Direct testing of blood samples to diagnose bloodstream infections[J]. ACS Infect Dis, 2025, 11(8):2051-2067. doi: 10.1021/acsinfecdis.5c00109 URL
[31]	MILLER W R, ARIAS C A. ESKAPE pathogens: Antimicrobial resistance, epidemiology, clinical impact and therapeutics[J]. Nat Rev Microbiol, 2024, 22(10):598-616. doi: 10.1038/s41579-024-01054-w pmid: 38831030
[32]	世界华人医学真菌专业委员会. 侵袭性肺真菌病诊断路径专家共识(2024版)[J]. 中华检验医学杂志, 2025, 48(4):459-468.
	World Society of Chinese Medical Mycology. Expert consensus on the diagnostic pathway for invasive pulmonary fungal disease (2024)[J]. Chin J Lab Med, 2025, 48(4):459-468.
[33]	World Health Organization. Landscape analysis of commercially available and pipeline in vitro diagnostics for fungal priority pathogens[M]. Geneva:WHO, 2025.
[34]	中华医学会检验医学分会. 病原微生物宏基因组测序生物信息分析及报告质量控制专家共识[J]. 中华检验医学杂志, 2025, 48(1):28-37.
	Chinese Society of Laboratory Medicine. Chinese expert consensus on quality control of bioinformatics analysis and standardized report for pathogen metagenomic next-generation sequencing[J]. Chin J Lab Med, 2025, 48(1):28-37.
[35]	XING X W, ZHANG J T, MA Y B, et al. Metagenomic next-generation sequencing for diagnosis of infectious encephalitis and meningitis: A large, prospective case series of 213 patients[J]. Front Cell Infect Microbiol, 2020,10:88.
[36]	ZHAO Y, LI MC, KONATÉ M M, et al. TPM, FPKM, or normalized counts? A comparative study of quantification measures for the analysis of RNA-seq data from the NCI patient-derived models repository[J]. J Transl Med, 2021,19:269.
[37]	ZHAO S, YE Z, STANTON R. Misuse of RPKM or TPM normalization when comparing across samples and sequencing protocols[J]. RNA, 2020, 26(8):903-909. doi: 10.1261/rna.074922.120 pmid: 32284352
[38]	WEBER A N R, MCMANUS R M, HORNUNG V, et al. The expanding role of the NLRP3 inflammasome from periodic fevers to therapeutic targets[J]. Nat Immunol, 2025, 26(9):1453-1466. doi: 10.1038/s41590-025-02230-7 pmid: 40826276
[39]	中国医院协会临床微生物实验室专业委员会. 新发突发呼吸道传染性病原微生物分级检测专家共识(2024)[J]. 协和医学杂志, 2025, 16(1):109-124.
	Chinese Hospital Association Clinical Microbiology Laboratory Specialized Committee. Expert consensus on tiered detection of newly emerging and outbreak respiratory infectious pathogens(2024)[J]. Med J Peking Union Med Coll Hosp, 2025, 16(1):109-124.
[40]	MILLER J M, BINNICKER M J, CAMPBELL S, et al. Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the infectious diseases society of America (IDSA) and the American society for microbiology (ASM)[J]. Clin Infect Dis,2024:ciae104.
[41]	WHITTAKER C, SLATER H, NASH R, et al. Global patterns of submicroscopic Plasmodium falciparum malaria infection: Insights from a systematic review and meta-analysis of population surveys[J]. Lancet Microbe, 2021, 2(8):e366-e374. doi: 10.1016/S2666-5247(21)00055-0 URL
[42]	WANG K, LI P, LIN Y, et al. Metagenomic diagnosis for a culture-negative sample from a patient with severe pneumonia by nanopore and next-generation sequencing[J]. Front Cell Infect Microbiol, 2020,10:182.
[43]	中华检验医学培训工程专家委员会,中华医学会呼吸病学分会. 成人呼吸道感染病原诊断核酸检测技术临床应用专家共识(2023)[J]. 协和医学杂志, 2023, 14(5):959-971.
	The Committee of Chinese Laboratory Medical Education, Chinese Thoracic Society of the Chinese Medical Association. Expert consensus on nucleic acid of amplification techniques test for the diagnosis of pathogens in adult respiratory tract infections(2023)[J]. Med J Peking Union Med Coll Hosp, 2023, 14(5):959-971.
[44]	REHMAN H, RAWAT A, GILL F S, et al. Clinical outcomes in blood culture-positive versus blood culture-negative infective endocarditis: A systematic review and meta-analysis[J]. Cureus,2025:e88134.
[45]	BJERKLUND JOHANSEN T E, BAHRS C, BRUYERE F, et al. Consensus position statement on advancing the classification of patients and tests of cure in studies of antibiotic treatment of complicated urinary tract infections[J]. Lancet Infect Dis, 2025, 25(10):e605-e618. doi: 10.1016/S1473-3099(25)00142-2 pmid: 40378860
[46]	ROGER P M, FARHAD R, PULCINI C, et al. Elderly patients presenting with fever and respiratory problems in an intensive care unit. Diagnostic, therapeutic and prognostic impact of a systematic infectious disease consultation[J]. Presse Med, 2003, 32(36):1699-1704.
[47]	CARRASCO-ZANINI J, PIETZNER M, DAVITTE J, et al. Proteomic signatures improve risk prediction for common and rare diseases[J]. Nat Med, 2024, 30(9):2489-2498. doi: 10.1038/s41591-024-03142-z
[48]	ANTONIADOU C, GAVRIILIDIS E, CHATZOPOULOS P, et al. Fever and inflammation of unknown origin in the 21st century[J]. Eur J Intern Med, 2025,142:106443.
[49]	RAMAKRISHNAN R, WASHINGTON A, SUVEENA S, et al. From DNA to big data: NGS technologies and their applications[M]// Artificial Intelligence (AI) in Cell and Genetic Engineering. NewYork, NY: Springer US,2025:459-482.

病原体类型	推荐等级	适用场景	备注
病毒
核酸扩增检测	++++	急性期诊断、精准溯源	高灵敏度、高特异度
病毒抗原床旁即时检测检测	++	门急诊快速分诊、群体筛查	快速便捷，灵敏度略低
细菌
标本培养+药敏试验	++++	所有疑似细菌感染病例	诊断金标准，指导抗菌药物选择
血培养	++++	疑似败血症、血流感染	寒战/体温上升初期采集，提高阳性率
真菌
G试验/GM试验	+++	侵袭性真菌感染广谱筛查	GM试验对曲霉感染提示价值高
真菌培养	++++	明确真菌种类，指导抗真菌治疗	生长缓慢，需联合其他技术
非典型病原体
核酸检测	+++	支原体、衣原体、立克次体感染	早期诊断首选
血清学抗体检测	++	恢复期确诊、流行病学调查	双份血清抗体滴度4倍升高有确诊意义
寄生虫
核酸检测/抗原快速检测	+++	疟疾、弓形虫等感染，疫区旅居史者	快速精准，适配高危人群
涂片镜检	++	疟疾流行区常规筛查	操作简便，基层可开展
通用检测
宏基因组高通量测序	+++	重症、疑难、常规检测阴性病例	可识别难培养、新发病原体