摘要
目的评估质谱快速鉴定联合直接药敏试验在革兰阴性细菌血流感染诊断中的临床应用价值。方法对2021年8月-2022年3月我院133瓶血培养阳性标本经SDS沉淀离心富集细菌后,使用基质辅助激光解吸电离飞行时间质谱(MALDITOF MS)直接鉴定,对阳性血培养液进行直接快速药敏试验(RAST),同时对培养后的菌落进行质谱鉴定和VITEK 2 Compact药敏分析,比较两种方法的一致性。结果133例血培养阳性标本经鉴定后革兰阴性细菌共122株,直接细菌鉴定的准确率为91.73%,包括大肠埃希菌56株、肺炎克雷伯菌26株、鲍曼不动杆菌12株和铜绿假单胞菌12株,其中鲍曼不动杆菌检出率最高为100.00%,阴沟肠杆菌最低为66.67%;所有药物结果符合(CA)比例在4、6、8 h呈现逐渐升高现象;在8 h时除了哌拉西林/他唑巴坦(TZP)和美罗培南(MEN),其他药物的CA均高于可接受值(CA>90%),仅有1例铜绿假单胞菌对TZP的药敏结果在6、8 h时为非常重大错误(VME),1例大肠埃希菌对TZP、阿米卡星(AK)在4、6、8 h时均为重大错误(ME),2例肺炎克雷伯菌对TZP、头孢他啶(CAZ)在4、6、8 h时为ME,1例铜绿假单胞菌对妥布霉素(TOB)和庆大霉素(CN)在6、8 h时为微小错误(mE)。结论5%SDS沉淀法联合MALDI-TOF MS直接鉴定细菌菌种准确性高,RAST的CA比例高,8 h可作为革兰阴性细菌RAST药敏判读的最佳时间点,对于及时指导临床用药及改善患者预后具有重要意义。
Objective To evaluate the clinical application value of mass spectrometry rapid identification combined with rapid antimicrobial susceptibility testing in the diagnosis of gram-negative bacterial blood stream infection.Methods From August 2021 to March 2022,133 blood culture positive specimens in our hospital were enriched by SDS precipitation centrifugation,and the bacteria were directly identified by matrix-assisted laser desorption ionization time-of-flight mass spectrometry(MALDI-TOF MS).Rapid antimicrobial susceptibility testing(RAST)was performed on the positive blood culture medium,and the cultured colonies were identified by mass spectrometry and VITEK 2 Compact drug sensitivity analysis.The consistency of the two methods was compared.Results There were 122 strains of gram-negative bacteria in 133 blood culture positive samples after direct identification,the accuracy was 91.73%.Among them,there were 56 strains of Escherichia coli,26 strains of Klebsiella pneumoniae,12 strains of Acinetobacter baumannii and 12 strains of Pseudomonas aeruginosa.The highest detection rate of Acinetobacter baumannii was 100.00%,and the lowest detection rate of Enterobacter cloacae was 66.67%.The proportion of CA in all drugs increased gradually at 4,6 and 8h time points.At the 8 h time point,except for piperacillin/tazobactam(TZP)and meropenem(MEM),CA results were above the acceptable value(categorial agreement,CA>90%).Only 1 case of TZP in Pseudomonas aeruginosa showed very major error(VME)at 6 and 8 h;1 case of TZP and amikacin(AK)in Escherichia coli showed major error(ME)at 4,6 and 8 h;2 cases of TZP and ceftazidime(CAZ)of in Klebsiella pneumoniae showed ME at 4,6 h and 8 h;1 case of tobramycin(TOB)and gentamicin(CN)in Pseudomonas aeruginosa showed minor error(mE)at 6 and 8 h.Conclusion The accuracy of 5%SDS precipitation combined with MALDI-TOF MS for the direct identification of pathogenic bacteria is high,RAST has a high CA ratio,8 h can be used as the optimal time point for RAST susceptibility of gram-negative bacteri
作者
张小云
刘本
连建春
姜玉章
唐朝贵
王霞
HANG Xiao-yun;LIU Ben;LIAN Jian-chun;JIANG Yu-zhang;TANG Chao-gui;WANG Xia(Department of Clinical Laboratory,the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University,Huai'an 223300,Jiangsu,China)
出处
《医学信息》
2023年第3期98-103,共6页
Journal of Medical Information
关键词
血流感染
革兰阴性杆菌
质谱快速鉴定
直接快速药敏试验
基质辅助激光解吸电离飞行时间质谱
Blood stream infection
Gram-negative bacteria
Rapid identification
Rapid antimicrobial susceptibility testing
Matrix-assisted laser desorption ionization time-of-flight mass spectrometry
